Seminars in Arthroplasty最新文献

{"title":"Is there a role for acromioplasty and tuberoplasty in reverse shoulder arthroplasty to improve impingement-free range of motion?","authors":"María Brotat-Rodríguez MD, PhD ,&nbsp;Juan David Lacouture MD ,&nbsp;Riccardo Ranieri MD ,&nbsp;Olivier Dhollander MD ,&nbsp;Pascal Boileau MD, PhD","doi":"10.1053/j.sart.2024.03.008","DOIUrl":"10.1053/j.sart.2024.03.008","url":null,"abstract":"<div><h3>Hypothesis and Background</h3><p>Lateralizing the center of rotation in reverse shoulder arthroplasty<span> (RSA) decreases the risk of scapular notching due to inferior impingement but may limit range of motion (ROM) in abduction and forward flexion related to superior acromial impingement. Our primary hypothesis was that, using a 3-dimensional (3D) computer model, a virtual acromioplasty (with or without tuberoplasty) could improve abduction and forward flexion following RSA for cuff tear arthritis (CTA) or massive cuff tear. Our secondary hypothesis was that, based on the virtual planning, a surgical acromioplasty could be performed safely during RSA, without increasing the risk of postoperative acromial fracture.</span></p></div><div><h3>Methods</h3><p>Eighty seven patients with CTA scheduled for RSA were analyzed with a 3D software and impingement-free ROM was measured. After virtual prosthesis implantation, early acromio-humeral impingement (abduction ≤ 80° or forward flexion ≤ 120°) was observed in 25% of the cases (22/87). A virtual acromioplasty (with or without tuberoplasty) was then performed and glenohumeral ROM was measured again. Based on this 3D planning, a surgical acromioplasty (with or without tuberoplasty) was performed to improve ROM in the vertical plane in these 22 patients with early acromial impingement. Patients were followed with minimum 24 months of follow-up to assess final shoulder ROM and complications.</p></div><div><h3>Results</h3><p>After virtual acromioplasty alone (n = 11) or acromioplasty with tuberoplasty (n = 11), glenohumeral abduction significantly increased from 75° ± 6.9 before to 89.5° ± 23.4, and forward flexion from 119.3° ± 12 to 135.2° ± 10 (<em>P</em> &lt; .001). After surgical acromioplasty/tuberoplasty, the final mean global forward flexion was 148° ± 5 and mean global abduction 150° ± 8 in these patients. At last follow-up, no acromial fracture was observed.</p></div><div><h3>Conclusion</h3><p>In a 3D model, early acromial impingement may limit abduction (≤80°) or forward flexion (≤120°) after virtual RSA implantation for CTA or massive cuff tear. Virtual acromioplasty (with or without tuberoplasty) shows improved ROM in abduction and flexion. In patients with early impingement, a surgical acromioplasty can be performed safely during RSA, through a deltopectoral approach, without increasing the risk of postoperative acromial fracture.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 617-625"},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048849","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":"Three-dimensional scapular orientation: a comparison of glenohumeral osteoarthritis and cuff tear arthropathy to the unaffected shoulder","authors":"Teja Polisetty BS ,&nbsp;Ryan Lohre MD ,&nbsp;Evan A. Glass BS ,&nbsp;Daniel P. Swanson BS ,&nbsp;Adam R. Bowler BA ,&nbsp;Sanne Vancleef PhD ,&nbsp;Ward Bartels PhD ,&nbsp;Randa Elmallah MD ,&nbsp;Bassem Elhassan MD ,&nbsp;Jacob M. Kirsch MD ,&nbsp;Eric T. Ricchetti MD ,&nbsp;Andrew Jawa MD","doi":"10.1053/j.sart.2024.03.009","DOIUrl":"10.1053/j.sart.2024.03.009","url":null,"abstract":"<div><h3>Background</h3><p>Scapular orientation may play an important role in preoperative planning for shoulder arthroplasty; however, there is currently no defined method for producing standardized three-dimensional measurements. The purpose of this study is to develop a reproducible measurement system of scapular orientation and to evaluate differences between unaffected shoulders and those with diagnoses of primary glenohumeral osteoarthritis (GHOA) and rotator cuff tear arthropathy (CTA).</p></div><div><h3>Methods</h3><p>Patients receiving computed tomography scans for preoperative shoulder arthroplasty planning were enrolled prospectively. Thin sliced axial images that included bilateral shoulders and the thorax were reformatted. The pathology of the bilateral glenohumeral joints was defined as GHOA, CTA, or unaffected. Scapular orientation was defined relative to the thorax using three-dimensional models to define the protraction, rotation, and tilt angles in the supine position. Univariate analysis was performed to compare demographics and scapular measurements between patients with GHOA, CTA, and unaffected shoulder pathology. Multivariate linear regression analysis was performed to identify independent predictors of scapular orientation.</p></div><div><h3>Results</h3><p>One hundred fifty-eight shoulders, comprising 79 patients were included. Twenty-seven percent (n = 21/79) of patients had an unaffected contralateral shoulder. Shoulders with GHOA had significantly greater downward scapular rotation (-14 ± 7 degrees) than both unaffected shoulders (-8 ± 7 degrees; <em>P</em> &lt; .001) and those with CTA (-7 ± 8 degrees; <em>P</em> &lt; .001). Increased downward scapular rotation was predicted by a shoulder pathology of GHOA in multivariate analysis (beta -7.09; <em>P</em> &lt; .001). The magnitude of side-to-side difference was greatest in scapular rotation for patients with GHOA compared to CTA, with no significant differences in tilt or protraction.</p></div><div><h3>Conclusion</h3><p>Scapular rotation in the supine position varies by shoulder pathology, with greater downward rotation seen in patients with primary GHOA. These findings underscore the need for awareness of scapular orientation in addition to glenoid morphology when evaluating and planning shoulder arthroplasty cases.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 639-647"},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000476/pdfft?md5=faa7884f850257b607c13730e6f3901c&pid=1-s2.0-S1045452724000476-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049865","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}

{"title":"Prognostic value of the Favard classification for patients before and after reverse shoulder arthroplasty performed for rotator cuff tear arthropathy","authors":"Kevin A. Hao BS ,&nbsp;Josie Elwell PhD ,&nbsp;Pierre-Henri Flurin MD ,&nbsp;Thomas W. Wright MD ,&nbsp;Bradley S. Schoch MD ,&nbsp;Christopher P. Roche MSE, MBA ,&nbsp;Christopher A. Colasanti MD ,&nbsp;Joseph D. Zuckerman MD ,&nbsp;Ryan W. Simovitch MD","doi":"10.1053/j.sart.2024.03.010","DOIUrl":"10.1053/j.sart.2024.03.010","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Although the Favard classification is commonly utilized by surgeons to describe the supero-inferior morphology of the glenoid when treating rotator cuff&lt;span&gt; arthropathy&lt;span&gt; (RCA), its utility in prognosticating patients’ clinical state before and after reverse shoulder arthroplasty (RSA) remains unproven. We assessed the prognostic value of the Favard glenoid classification on preoperative clinical state and postoperative clinical and radiographic outcomes in RSA.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A prospectively collected, multicenter database for a single-platform shoulder arthroplasty system was queried for patients with RCA who underwent RSA with a minimum 2-year clinical follow-up. Differences in patient reported outcome scores (PROMs) (Simple Shoulder Test, American Shoulder and Elbow Surgeons, Shoulder Pain and Disability Index&lt;span&gt;&lt;span&gt;, visual analog scale pain, Shoulder Function score), combined patient-reported and clinical-input scores (Constant, University of California Los Angeles, Shoulder Arthroplasty Smart), active range of motion values (forward elevation, abduction, external rotation [ER], internal rotation [IR]), radiographic outcomes (humeral radiolucency line rates, scapular notching rate), and the incidence of &lt;/span&gt;postoperative complications and revision surgery were compared by glenoid deformity type per the Favard classification. Comparisons were performed to assess the ability of the Favard classification to prognosticate the preoperative, postoperative, and improved state after RSA.&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;400 RSAs performed for RCA were included. Comparison of outcomes between Favard glenoid types resulted in 6 pairwise comparisons of 12 clinical outcome metrics, yielding 72 total Favard glenoid pairwise comparisons for each clinical state (preoperative, postoperative, improvement). Of the 216 possible pairwise Favard glenoid type/metric comparisons, statistical significance was only reached for 3% of the combinations (7/216). Among E0, E1, and E2 glenoids, the only statistically significant pairwise comparison identified among all three clinical states was a more favorable preoperative American Shoulder and Elbow Surgeons score for E0 vs. E2 glenoids. Preoperatively, E3 glenoids had poorer ER, IR, and Shoulder Arthroplasty Smart scores compared to E0 glenoids and poorer ER compared to E2 glenoids. Postoperatively, E3 glenoids had a poorer IR score compared to E0 glenoids and poorer ER compared to E1 glenoids. No pairwise differences in preoperative to postoperative improvement were found. There were no statistically significant pairwise differences in humeral lucency rate, scapular notching rate, complication rates, or revision rates between Favard glenoid types.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p&gt;Although useful for describing degenerative changes to the glenohumeral joint, the Favard classification offers little prognostic information regarding patien","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 648-656"},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049864","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":"Race, gender, and income negatively impact patient-reported outcomes following total shoulder arthroplasty","authors":"Joshua P. Castle MD,&nbsp;Michael A. Gaudiani MD,&nbsp;Johnny K. Kasto MD,&nbsp;Noah Elagamy BS,&nbsp;Matthew A. Gasparro BS,&nbsp;Matthew Corsi BS,&nbsp;Eric X. Jiang MD,&nbsp;Eric C. Makhni MD,&nbsp;Jared M. Mahylis MD,&nbsp;Stephanie J. Muh MD","doi":"10.1053/j.sart.2024.03.006","DOIUrl":"10.1053/j.sart.2024.03.006","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Social determinants of health&lt;span&gt; (SDOH) refer to social and economic factors that influence a patient’s health status. The purpose of this study was to investigate the impact of SDOH on preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores and postoperative resource utilization following primary shoulder arthroplasty (SA).&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;&lt;span&gt;&lt;span&gt;&lt;span&gt;This retrospective chart review evaluated data from all patients who underwent primary SA (including anatomic, reverse, and hemiarthroplasty) at a single health system between May 2020 and May 2022. Patients without at least 6-month postoperative PROMIS questionnaires and those undergoing revision surgeries were excluded. The &lt;/span&gt;electronic medical record was used to identify SDOH for each patient, and PROMIS scores for Upper Extremity (PROMIS-UE), Pain Interference (PROMIS-PI), and Depression (PROMIS-D) were completed electronically at respective preoperative and postoperative visits. &lt;/span&gt;Univariate analysis using independent 2-group &lt;/span&gt;&lt;em&gt;t&lt;/em&gt;&lt;span&gt;-tests and Chi-squared tests were used to analyze the mean difference between patient groups based on SDOH. Multivariate linear regressions&lt;span&gt; were performed with all predictors used in the univariate model using the least squares method.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The study included 248 patients who underwent SA, with a mean age of 67.9 years. Caucasian patients were over-represented in the highest quartile of median household income (MHI) compared to Black patients (35.1% vs. 17.2%) who were over-represented in the lowest MHI quartile (37.9% vs. 8.3%). At 6-month postoperative, black patients had significantly lower UE (33.8 ± 6.2 vs. 38.1 ± 9.0; &lt;em&gt;P&lt;/em&gt; = .03) and greater PI scores (59.1 ± 6.1 vs. 55.6 ± 8.6; &lt;em&gt;P&lt;/em&gt; = .145) compared to Caucasian patients. Similarly, at 6-month follow-up, the lowest MHI quartile had lower UE (33.8 ± 7.7 vs. 39.6 ± 8.8; &lt;em&gt;P&lt;/em&gt; = .01) and higher PI scores (58.7 ± 6.5 vs. 54.3 ± 8.2; &lt;em&gt;P&lt;/em&gt; &lt; .01) compared to the highest MHI quartile, and females demonstrated lower UE (36.3 ± 7.9 vs. 38.6 ± 9.8; &lt;em&gt;P&lt;/em&gt; = .04) and higher D scores (46.2 ± 9.1 vs. 42.0 ± 8.6; &lt;em&gt;P&lt;/em&gt; = .046) compared to males. Government/public insurance demonstrated lower UE (36.8 ± 8.0 vs. 39.8 ± 10.4; &lt;em&gt;P&lt;/em&gt; = .03) and higher D scores (45.9 ± 9.2 vs. 40.6 ± 7.6; &lt;em&gt;P&lt;/em&gt; = .03) compared to private insurance. At 12-month follow-up, females demonstrated lower UE scores compared to males (36.0 ± 10.2 vs. 40.1 ± 11.3; &lt;em&gt;P&lt;/em&gt; = .03). Black patients harbored lower UE, PI, and D scores compared to Caucasian patients, although not statistically significant.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p&gt;Several socioeconomic factors such as race, gender, and insurance status are associated with differential outcomes after SA. Patients who are Black, female, current smokers, and from the lowest in","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 608-616"},"PeriodicalIF":0.0,"publicationDate":"2024-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048848","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":"Sleep apnea in patients undergoing reverse shoulder arthroplasty is associated with greater complications and healthcare utilization","authors":"","doi":"10.1053/j.sart.2024.02.010","DOIUrl":"10.1053/j.sart.2024.02.010","url":null,"abstract":"<div><h3>Background</h3><p><span>Sleep apnea<span> (SA) has been shown to negatively affect cognition, immunity, and bone mineralization. There is conflicting evidence for the contribution of SA to outcomes following </span></span>total shoulder arthroplasty<span>. However, the impact of SA on reverse shoulder arthroplasty (RSA) has not been elucidated. A substantial increase in utilization of RSA is projected through the 2030s. Our objective was to assess postoperative medical and implant-related complications and healthcare utilization in patients with SA undergoing RSA.</span></p></div><div><h3>Methods</h3><p>A retrospective review of a private insurance claims database was conducted from 2010 to 2021. All cases of RSA and those with a prior diagnosis of SA were identified using their corresponding diagnosis and procedural codes. Patients undergoing RSA with a diagnosis of SA were matched to control patients 1:2 based on demographic and comorbidity profiles.</p></div><div><h3>Results</h3><p>A total of 18,229 SA patients were matched to 35,988 control patients. The SA cohort had significantly greater odds of all medical complications assessed compared to the control cohort. The SA cohort had greater odds of all implant-related complications including dislocation and mechanical loosening when compared to the control cohort. Mean length of stay was significantly greater in the SA group.</p></div><div><h3>Conclusion</h3><p>The current data demonstrate that SA patients may have an increased risk of complications and healthcare burden following RSA compared to RSA patients without SA. These findings indicate potential value in preoperative screening for SA prior to RSA.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 571-576"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140777042","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":"Intraoperative changes to the components planned preoperatively do not affect short-term, postoperative clinical outcomes after reverse total shoulder arthroplasty","authors":"","doi":"10.1053/j.sart.2024.03.001","DOIUrl":"10.1053/j.sart.2024.03.001","url":null,"abstract":"<div><h3>Background</h3><p>Three-dimensional, computed tomography<span> preoperative planning has been increasingly adopted among shoulder arthroplasty<span> surgeons. Prior studies have not examined outcomes in patients undergoing reverse total shoulder arthroplasty in which the surgeon implanted prostheses that deviated from the preoperative plan compared to patients in which the surgeon followed the preoperative plan. The hypothesis of this study was that clinical outcomes would not be different between patients in which the surgeon utilized components that deviated from those predicted in the preoperative plan and patients in which the surgeon followed the preoperative plan.</span></span></p></div><div><h3>Methods</h3><p>A retrospective review of patients that had preoperative planning for reverse total shoulder arthroplasty<span> from April 2017 through February 2022 was performed. Patients were stratified into two groups: patients in which the surgeon utilized components that deviated from those anticipated by the preoperative plan (changed group), and patients in which the surgeon utilized all of the components anticipated by the preoperative plan (as planned group). Patient-reported outcomes including the Western Ontario Osteoarthritis<span> Index, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Shoulder Activity Level were recorded preoperatively, at one year, and at two years. Preoperative and one-year postoperative range of motion was recorded.</span></span></p></div><div><h3>Results</h3><p>One hundred and eighty-nine patients were included in this study. One hundred forty-seven patients had intraoperative changes to their preoperative plan and 42 patients underwent reverse total arthroplasty without changes to their preoperative plan. There was no difference determined between any patient-reported outcome score at the one- and two-year postoperative time points between the as planned group and the changed group. No differences were found in range of motion between groups. Patients initially planned to undergo anatomic total shoulder arthroplasty that were intraoperatively converted to a reverse total shoulder arthroplasty had equivalent outcomes compared to those that had 1) other intraoperative deviations or 2) had no changes to their original preoperative plan.</p></div><div><h3>Conclusion</h3><p>Patients undergoing reverse total shoulder arthroplasty that had an intraoperative deviation to the components utilized in the preoperative plan had equivalent 1) patient-reported outcomes at one and two years after surgery and 2) range of motion one year after surgery compared to those that did not change from the preoperative plan. This study suggests it is safe to make intraoperative changes to the components utilized in the preoperative plan without concern for inferior postoperative outcomes when performing reverse total shoulder arthroplasty.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 585-592"},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766278","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":"Uncemented reverse shoulder arthroplasty in proximal humeral fractures: comparative study of two different press fit stems","authors":"Marta Navarro Bosch MD ,&nbsp;Jose Enrique Aroca Navarro MD ,&nbsp;Juan Aguilar Gonzalez MD","doi":"10.1053/j.sart.2024.03.003","DOIUrl":"10.1053/j.sart.2024.03.003","url":null,"abstract":"<div><h3>Background</h3><p><span>Reverse shoulder arthroplasty (RSA) has extended its indications in recent years to include complex </span>proximal humerus fractures (PHFs) in elderly patients. The traditional approach in cases of PHF has been to cement the stem but, as in orthopedic surgery, the current trend in PHF is to avoid cementing the humeral stem as well.</p></div><div><h3>Methods</h3><p>We evaluated 63 patients (representing 63 shoulders) who underwent RSA with uncemented stem after acute fracture of the proximal humerus. We analyzed the clinical and radiological outcomes, as well as medium-term complications, using two different prosthesis models.</p></div><div><h3>Results</h3><p><span><span>The mean postoperative follow-up period was 21-23 months, and the mean age of the patients was 74.5 years. The average Constant Score was 56.94 points; there were no statistical significant differences in Constant Score depending on the prosthesis model used. No cases of aseptic loosening were observed. However, there was evidence of stress-shielding in prostheses with diaphyseal fixation, although this phenomenon did not appear to have functional or clinical consequences for the patients. </span>Intraoperative complications occurred in 6.35% of cases, and </span>postoperative complications were noted in 4.92%.</p></div><div><h3>Conclusion</h3><p>Based on the results of this study, we can affirm that the use of RSA with cementless stems in PHF can be a safe alternative, providing satisfactory clinical, functional, and radiographic results in the short term without the need to use cement in their fixation. The choice of prosthesis model may influence the occurrence of radiographic phenomena but does not seem to affect clinical outcome.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 593-601"},"PeriodicalIF":0.0,"publicationDate":"2024-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048847","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":"Clinical evaluation of patients over the age of 75 receiving either anatomic or reverse total shoulder arthroplasty: a single-institution retrospective analysis","authors":"","doi":"10.1053/j.sart.2024.03.002","DOIUrl":"10.1053/j.sart.2024.03.002","url":null,"abstract":"<div><h3>Background</h3><p>Anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are proven surgical treatment options for both traumatic and degenerative conditions of the shoulder. Our objective is to report both clinical and patient-reported outcomes (PROs) of patients over the age of 75 at the time of arthroplasty. We hypothesize no functional difference in outcomes between patient groups.</p></div><div><h3>Methods</h3><p>Patients over the age of 75 at the time of surgery who received primary aTSA or rTSA between 2009 and 2020 with a minimum of two-year follow-up were selected. A retrospective chart review was performed. Patients 60-75 were included as a control group. 2:1 propensity matching using sex, Charlson Comorbidity Index, preoperative forward elevation (FE), and external rotation (ER) was used in selecting a comparison cohort of patients 60-75. Statistical analysis included the <em>t</em>-test, Wilcoxon signed-rank test, and chi-squared test.</p></div><div><h3>Results</h3><p>For aTSA, 25 patients older than 75 years fit the inclusion criteria. The mean follow-up time was 4.2 (2.0-12.0) years. aTSA patients over the age of 75 had significant improvements in FE 111 to 141 degrees (<em>P</em> = .007), ER 28 to 44 degrees (<em>P</em> &lt; .001), and internal rotation (IR) sacrum to L4 (<em>P</em> = .003). There were also improvements in FE strength (FES) 4+/5 to 5/5 (<em>P</em> = .0303) and IR strength (IRS) but not ER strength (ERS) from 4+/5 to 5/5 (<em>P</em> = .098). There was no significant difference in range of motion (ROM), strength, or PROs between age groups (&gt;75 years vs. 60-74 years). For rTSA, 47 patients older than 75 years fit the inclusion criteria. Average clinical follow-up was 3.5 (2.0-10.6) years. Patients demonstrated ROM improvements in ER (31 to 40 degrees, <em>P</em> = .0413), FE (96 to 138 degrees, <em>P</em> &lt;.001) but not IR (L5 to L4, <em>P</em> = .3509). There were significant improvements in postoperative strength in FES (4-/5 to 4+/5, <em>P</em> &lt;.001), ERS (4-/5 to 4+/5, <em>P</em> &lt;.001), and IRS (4/5 to 5/5, <em>P</em> &lt;.001). The only significant difference between propensity-matched age groups was postoperative IR (L4 to L5, <em>P</em> = .013). There were no significant differences in PROs between different age groups.</p></div><div><h3>Conclusion</h3><p>aTSA and rTSA provide significant improvements in ER, FE, ROM, ERS, FES, and IRS in patients over the age of 75 with no significant difference in outcomes compared to a younger cohort.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 577-584"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1045452724000403/pdfft?md5=e597892d3cd0c21dbf00aa2f9c77d35c&pid=1-s2.0-S1045452724000403-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792802","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}

{"title":"Comparison of genomic DNA sequencing to anerobic cultures to detect efficacy of hydrogen peroxide at reducing cutibacterium acnes bacterial burden during primary shoulder arthroplasty","authors":"","doi":"10.1053/j.sart.2024.02.006","DOIUrl":"10.1053/j.sart.2024.02.006","url":null,"abstract":"<div><h3>Background</h3><p><span><span>The purpose of this investigation is to compare Cutibacterium acnes diagnosis using culturing vs. </span>genomic DNA sequencing (NextGen) at various timepoints and locations during primary </span>total shoulder arthroplasty<span>. Additionally, we intend to compare the effects of hydrogen peroxide on standard culture technique results with genomic DNA sequencing.</span></p></div><div><h3>Methods</h3><p>A prospective diagnostic study of 40 patients undergoing primary total shoulder arthroplasty was performed. Intraoperatively, 4 tissue samples were collected per patient: subdermal skin edge following initial skin incision<span><span><span>, subdermal skin edge following hydrogen peroxide soak for 5 minutes, glenohumeral joint capsule, and subdermal skin edge prior to </span>wound closure. Each tissue specimen was collected twice (one for culture analysis and the other for genomic (NextGen) DNA sequencing analysis) for a total of 8 specimens per patient and 320 tissue specimens in total. All anaerobic cultures were held for 14 days. Each culture plate was divided into quadrants and the amount of growth was quantified. Tissue samples were collected for </span>genomic sequencing<span> DNA analysis. Genomic sequencing results provided relative percentage of bacteria for each specimen detected.</span></span></p></div><div><h3>Results</h3><p><span>There were 18/40 males (45%) and no postoperative complications<span><span>. Average age was 72.2 ± 11.8. Overall, 18% (29/160) of standard anaerobic cultures were positive for C. Acnes and 26% (942/160) were positive with genomic (Nextgen) DNA sequencing. When comparing the NextGen results with anaerobic standard cultures, there was a calculated negative predictive value of 85.6% and positive predictive value of 28.6%. Sensitivity of the NextGen was 41.4% and specificity was 77.1%. </span>Bacterial culture rates did not significantly change from the beginning to the end of surgery as demonstrated on standard culturing and the NextGen analysis (</span></span><em>P</em> &gt; .05). After treatment with hydrogen peroxide, the standard culturing technique showed no significant difference between the samples; however, there was a significant increase in bacterial burden (12.4%) noted with NextGen analysis (<em>P</em> = .0147).</p></div><div><h3>Conclusion</h3><p>NextGen culturing is a novel technique to help identify shoulder prosthetic joint infections. These results show that, NextGen is better at identifying the absence<span> of infection, but has a high false positive rate indicative of its ability to identify contaminants as compared to standard anaerobic culturing methods. The increase in bacterial burden after peroxide treatment noted with NextGen could also be secondary to the test’s increased ability to identify both living and dead bacterial pathogens.</span></p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 3","pages":"Pages 552-557"},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic shoulder arthroplasty in patients 40 years or younger","authors":"Evan M. Banks BS ,&nbsp;Jonathan P. Braman MD ,&nbsp;Alicia K. Harrison MD ,&nbsp;Allison J. Rao MD","doi":"10.1053/j.sart.2024.02.009","DOIUrl":"10.1053/j.sart.2024.02.009","url":null,"abstract":"<div><h3>Background</h3><p>Glenohumeral arthritis in adults less than 40 years old represents a challenging clinical scenario to manage. While patients older than 55 have had reproducible success with current shoulder arthroplasty techniques, young patients have historically had less successful outcomes, possibly due to higher physical demands and more complex pathologies. Despite these concerns, anatomic total shoulder arthroplasty (TSA) remains the treatment of choice for young, active patients with severe glenohumeral arthritis and intact rotator cuff. We hypothesize that TSA provides significant relief in pain and functional outcomes in patients less than 40 years old.</p></div><div><h3>Methods</h3><p>We performed a single-institution retrospective analysis of consecutive patients aged 40 years and younger who underwent TSA between 2007 and 2022. Demographic data included age, sex, body mass index, Charlson comorbidity index, and preoperative diagnosis. Outcome measures included the Single-Assessment Numerical Evaluation (SANE) score, final range of motion, complications, and revision rate. Statistically significant differences between variables were evaluated using a 2-sample t-test at an α level of <em>P</em> &lt; .05.</p></div><div><h3>Results</h3><p>Twenty-six TSAs were performed in 23 patients with an average final follow-up of 2 years after the procedure. The average age was 33.4 ± 5.3 years with a range of 19-39 years. The most common preoperative diagnosis was osteoarthritis (46%), followed by rheumatoid arthritis (27%) and osteonecrosis/avascular necrosis (19%). The most common glenoid morphology was type B (15) of which 14 were B2 glenoid, followed by type A (11). The SANE score, mean active forward elevation, abduction, external rotation, and internal rotation all improved significantly (<em>P</em> &lt; .05) by the final follow-up. On average, patients in all groups were able to achieve minimal clinically important difference in SANE score after 1 year. There was 1 complication reported of an early postoperative infection treated with irrigation and débridement, and no revision surgeries were performed during the follow-up period.</p></div><div><h3>Discussion/Conclusion</h3><p>TSA significantly improved functional outcome measures in patients less than 40 years old with a low rate of complications and revisions in short-term outcomes. As the frequency of TSA continues to increase in adults less than 40 years old, additional studies recording long-term functional outcomes and implant survivorship in this population can be explored.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 524-531"},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140404900","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}