Seminars in Arthroplasty最新文献_第7页

The hospital frailty risk score outperforms other risk stratification indices at predicting complications following total shoulder arthroplasty 在预测全肩关节置换术后并发症方面，医院衰弱风险评分优于其他风险分层指标

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2025-05-08 DOI: 10.1053/j.sart.2025.04.004

John W. Moore BS , Sophia Sitsis BS , Vivek Pandey BS , Alexander S. Guareschi MD , Jason Silvestre MD , Brandon L. Rogalski MD , Josef K. Eichinger MD , Richard J. Friedman MD, FRCSC

Background

Frailty and comorbidity indices are commonly used to stratify risk in orthopedic patients. The purpose of this study was to examine the hospital frailty risk score (HFRS), Elixhauser Comorbidity Index (ECI), Charlson-Deyo Comorbidity Index (CCI), and Modified 5-Item Frailty Index (mFI-5) to determine which index more accurately predicted complications following primary total shoulder arthroplasty (TSA).

Methods

The Nationwide Readmissions Database was queried from 2016 to 2021 to identify primary TSAs. HFRS, ECI, CCI, and mFI-5 scores were calculated. Generalized additive models were used to evaluate each index. Accuracy was assessed using the area under the curve of the receiver operative curve (AUC of ROC).

Results

HFRS was superior at predicting any complication, any medical complication, any surgical complication, revision, periprosthetic fracture, prosthetic loosening, complications requiring débridement, transfusion, Acute Respiratory Disease Syndrome (ARDS), acute renal failure, pneumonia, sepsis, and urinary tract infection. ECI was superior at predicting readmission, postoperative bleeding, and pulmonary embolism. CCI and mFI-5 were not superior to the other indices.

Discussion

The HFRS outperformed all other risk stratification indices at predicting rates of any complication, any surgical complication, any medical complication, revision, infection requiring débridement, periprosthetic fracture, prosthetic loosening, ARDS, acute renal failure, pneumonia, sepsis, transfusion, and urinary tract infection. ECI was the second-best index and outperformed all other indices at predicting rates of readmission and pulmonary embolism. No index was acceptable (AUC of ROC >0.7) at predicting surgical complications, readmissions, or revisions. These results indicate the HFRS may be the best risk stratification index for predicting complications following primary TSA.

背景：虚弱和合并症指标通常用于骨科患者的风险分层。本研究的目的是检查医院衰弱风险评分（HFRS）、Elixhauser合并症指数（ECI）、Charlson-Deyo合并症指数（CCI）和改良5项衰弱指数（mFI-5），以确定哪种指数更准确地预测原发性全肩关节置换术（TSA）后的并发症。方法查询2016 - 2021年全国再入院数据库，确定主要TSAs。计算HFRS、ECI、CCI和mFI-5评分。采用广义加性模型对各指标进行评价。使用受试者工作曲线曲线下面积（AUC of ROC）评估准确性。结果shfrs在预测并发症、内科并发症、外科并发症、翻修、假体周围骨折、假体松动、需要换装的并发症、输血、急性呼吸系统疾病综合征（ARDS）、急性肾功能衰竭、肺炎、败血症和尿路感染等方面均具有优势。ECI在预测再入院、术后出血和肺栓塞方面具有优势。CCI和mFI-5均不优于其他指标。HFRS在预测任何并发症、任何手术并发症、任何内科并发症、翻修手术、需要进行手术的感染、假体周围骨折、假体松动、急性呼吸窘迫综合征、急性肾功能衰竭、肺炎、败血症、输血和尿路感染的发生率方面优于所有其他风险分层指标。ECI是第二好的指标，在预测再入院率和肺栓塞率方面优于所有其他指标。在预测手术并发症、再入院或改期方面没有可接受的指标（ROC的AUC >；0.7）。这些结果表明，HFRS可能是预测原发性TSA并发症的最佳风险分层指标。

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引用次数: 0

Pullout strength of screws used for baseplate fixation in reverse shoulder arthroplasty: a cadaveric study 反向肩关节置换术中用于钢板固定螺钉的拉出强度：一项尸体研究

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2025-05-07 DOI: 10.1053/j.sart.2025.04.003

Masashi Kano MD , Shoji Fukuta MD, PhD , Jun Kawamata MD , Katsutoshi Miyatake MD, PhD , Kosaku Higashino MD, PhD , Keizo Wada MD, PhD , Koichi Tomita MD, PhD , Koichi Sairyo MD, PhD

Background

Previous studies have shown that bicortical screw fixation is biomechanically superior to unicortical screw fixation. However, no data are available on the pullout strength of screws used for glenoid fixation in reverse shoulder arthroplasty (RSA). The purpose of this study was to determine the differences in biomechanical strength between unicortical and bicortical fixation of the baseplate screws in RSA.

Methods

Both scapulae from 14 fresh frozen cadavers (7 men, 7 women) were used to compare the pullout strength of the superior and inferior screws used with the Trabecular Metal Reverse Shoulder System (Zimmer Biomet, Warsaw, IN, USA). Screws were inserted unicortically in one scapula of each specimen and bicortically in the other scapula. The pullout strength of each screw was evaluated using a universal testing machine.

Results

Mean pullout strength of the superior screws was 716.5 ± 300.4 N for unicortical fixation and 1241.3 ± 475.9 N for bicortical fixation, and that of the inferior screws was 272.3 ± 125.8 N and 666.2 ± 481.7 N, respectively. Pullout strength of the superior and inferior screws was significantly higher for bicortical fixation than for unicortical fixation. Pullout strength of the superior screws was 854.2 ± 314.0 N in unicortical fixation and 1374.7 ± 466.8 N in bicortical fixation in men, and 578.7 ± 209.6 N and 1107.8 ± 446.5 N, respectively, in women; the pullout strength of the inferior screws was 285.5 ± 139.0 N and 922.3 ± 549.5 N, respectively, in men, and 259.2 ± 109.5 N and 410.2 ± 176.4 N in women. Although the pullout strength was higher in men, the difference was not statistically significant, except for inferior bicortical screws. The ratio of the pullout strength for an inferior screw to that of a superior screw was 0.48. The ratio of the pullout strength for unicortical fixation to that of bicortical fixation was 0.58 for superior screws and 0.41 for inferior screws. The pullout strength of screws in women was 0.69 of that in men.

Conclusion

Bicortical screw fixation is stronger than unicortical screw fixation for the glenoid component in RSA, as in other regions. Pullout strength of the superior screws was significantly higher than that of the inferior screws in both unicortical and bicortical fixation. Fixation of inferior bicortical screws was impaired more significantly in women than in men. Therefore, bicortical fixation of the inferior screw is recommended for women and for patients with poor bone quality.

背景先前的研究表明双皮质螺钉固定在生物力学上优于单皮质螺钉固定。然而，在反向肩关节置换术（RSA）中用于肩关节固定的螺钉的拔出强度尚无数据。本研究的目的是确定RSA中单皮质和双皮质钢板螺钉固定在生物力学强度上的差异。方法采用14具新鲜冷冻尸体（男7名，女7名）的双肩胛骨，比较小梁金属反肩系统（Zimmer Biomet, Warsaw， IN， USA）使用的上、下螺钉的拉力。每个标本的一侧肩胛骨单皮质置入螺钉，另一侧肩胛骨双皮质置入螺钉。采用万能试验机对各螺杆的拉拔强度进行评估。结果单皮质内固定上螺钉的平均拔出强度为716.5±300.4 N，双皮质内固定为1241.3±475.9 N，下螺钉的平均拔出强度分别为272.3±125.8 N和666.2±481.7 N。双皮质固定的上、下螺钉的拔出强度明显高于单皮质固定。男性单皮质内固定上端螺钉的拉力为854.2±314.0 N，双皮质内固定为1374.7±466.8 N，女性分别为578.7±209.6 N和1107.8±446.5 N；下位螺钉的拉力男性分别为285.5±139.0 N和922.3±549.5 N，女性分别为259.2±109.5 N和410.2±176.4 N。虽然男性的拔出强度更高，但除了劣质双皮质螺钉外，差异无统计学意义。劣质螺钉与优质螺钉的拔出强度之比为0.48。单皮质内固定与双皮质内固定的拔出强度之比，优势螺钉为0.58，劣势螺钉为0.41。女性螺钉的拉力是男性的0.69。结论与其他区域一样，双皮质螺钉固定对RSA关节盂假体的作用强于单皮质螺钉固定。在单皮质和双皮质固定中，上螺钉的拔出强度明显高于下螺钉。下双皮质螺钉的固定在女性中比在男性中受损更明显。因此，对于女性和骨质量较差的患者，推荐采用双皮质下螺钉固定。

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引用次数: 0

Concomitant joint infection in shoulder periprosthetic fracture patients: a case series 肩关节假体周围骨折患者并发关节感染：一个病例系列

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2025-05-02 DOI: 10.1053/j.sart.2025.04.001

Alyssa R. Henriquez BS, Bryan Crook MD, Lindsey V. Ruderman BA, Samuel Lorentz MD, Christopher S. Klifto MD, Oke Anakwenze MD, MBA

引用次数: 0

Early clinical and radiological outcomes of a scapular spine load-bearing strut in custom glenoid implants for reverse total shoulder arthroplasty 肩胛骨负重支撑在定制肩关节置换术中的早期临床和放射学结果

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2025-04-29 DOI: 10.1053/j.sart.2025.03.009

Alastair J. Konarski FRCS, MBChB, BSc (Hons) , Leanne Dupley FRCS, MBChB , Nallamilli Rajyalakshmi Reddy MBBS, MS (Orth), MCh (Orth) , Ian A. Trail FRCS, MBChB , Michael J. Walton BMedSci, BMBS, MSc (SEM), FRCS (Tr&Orth) , Stephen Bale FRCS (Orth), MBChB, BSc , Puneet Monga FRCS (Orth), MBBS, DipSEM, MD

Background

Severe glenoid bone deficiency is a challenge in complex primary and revision shoulder arthroplasty, but lately, custom glenoid baseplates have demonstrated good outcomes. Lima Promade 3D-printed implants have recently utilized a strut to load share through the scapular spine to increase stability in patients with the most severe glenoid bone loss. We have assessed early clinical and radiological outcomes and reviewed complications.

Methods

This was a retrospective multisurgeon, single-center study, reviewing 19 patients with a minimum 2-year follow-up. Preoperative imaging was assessed for bone loss. Routinely performed postoperative computed tomography (CT) scans, radiographs, and Oxford Shoulder Scores were reviewed. CT scans were reported by independent musculoskeletal radiologists. Patient records were reviewed for any complications.

Results

19 patients with a mean age of 66 (42-89) and a mean follow-up of 3.6 years (2-8) were identified. 11 were revision procedures. 14/19 had severe bone loss (Seebauer-Gupta E4/C4) and 5 had severe dysplasia with >30° retroversion (Seebauer-Gupta E3/E4). 16/19 had a postoperative CT scan, with 14 showing good osseointegration; 1 reported partial osseointegration, and 1 suspected loosening but was asymptomatic. One patient had a magnetic resonance imaging scan with no suspicion of loosening. Pre and postoperative Oxford Shoulder Scores were available in 13 patients and improved from a mean of 14/48 preoperatively to 32/48 postoperatively. Complications were reported in 5 patients (26%), with 1 humeral component revision, 2 with limited external rotation, 1 acromial stress fracture, and 1 keloid scarring. No glenoid baseplates required revision.

Discussion

This is the first case series to report on the use of a scapular spine strut as part of a custom glenoid baseplate construct. Early outcomes report good osseointegration and good improvements in patient-reported outcome measures. The complication rate in our series was within the range described in the literature for complex shoulder replacement, and we report 100% implant survival at a minimum of 2 years. Early outcomes would suggest this is a safe technique to balance shear forces and improve stability in patients with severe glenoid bone loss and does not appear to increase the risk of acromial stress fractures beyond that reported in the literature. Further study is on-going to assess the medium- and long-term outcomes in these patients.

背景：严重的盂骨缺损在复杂的初次和翻修肩关节置换术中是一个挑战，但最近，定制盂骨基板显示出良好的效果。Lima Promade 3d打印植入物最近利用支柱通过肩胛骨负荷分担，以增加最严重肩胛骨丢失患者的稳定性。我们评估了早期临床和放射学结果，并回顾了并发症。方法本研究是一项多外科医生、单中心的回顾性研究，对19例患者进行了至少2年的随访。术前影像学检查骨质流失情况。术后常规计算机断层扫描（CT）、x线片和牛津肩部评分进行了回顾。CT扫描由独立的肌肉骨骼放射科医生报告。检查了病人的病历，看是否有并发症。结果19例患者平均年龄66岁（42 ~ 89岁），平均随访3.6年（2 ~ 8年）。11项为修订程序。14/19严重骨质流失（Seebauer-Gupta E4/C4）， 5例严重发育不良伴>；30°逆行（Seebauer-Gupta E3/E4）。16/19术后CT扫描，14例骨融合良好；1例报告部分骨整合，1例怀疑松动，但无症状。一名患者进行了磁共振成像扫描，没有怀疑松动。13例患者获得了术前和术后牛津肩部评分，从术前的平均14/48提高到术后的32/48。5例（26%）患者出现并发症，1例肱骨假体翻修，2例外旋受限，1例肩峰应力性骨折，1例瘢痕形成。无关节盂底板需要翻修。讨论：这是第一个使用肩胛骨支撑作为定制盂底板结构的病例系列报道。早期结果报告良好的骨融合和患者报告的结果测量的良好改善。在我们的研究中，复杂肩关节置换术的并发症发生率在文献中描述的范围内，我们报告了至少2年的100%假体存活率。早期结果表明，这是一种安全的技术，可以平衡剪切力，提高严重盂骨丢失患者的稳定性，而且除了文献报道外，似乎不会增加肩峰应力性骨折的风险。进一步的研究正在评估这些患者的中期和长期结果。

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引用次数: 0

COVID-19 infection within 6 months prior to total shoulder arthroplasty is an independent predictor of postoperative complications 全肩关节置换术前6个月内的COVID-19感染是术后并发症的独立预测因素

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2025-04-21 DOI: 10.1053/j.sart.2025.03.006

Jason Silvestre MD , Grace Bennfors MD , John W. Moore BS , Alexander S. Guareschi MD , Brandon L. Rogalski MD , Josef K. Eichinger MD , Richard J. Friedman MD, FRCSC

Background

The COVID-19 pandemic significantly disrupted elective orthopedic surgeries such as total shoulder arthroplasty (TSA). Recent studies have shown an increased risk of complications following elective orthopedic surgeries in patients with a recent COVID-19 diagnosis. However, similar research specifically addressing TSA is lacking. The purpose of this study is to determine whether preoperative COVID-19 infection within the 6 months before primary elective TSA is associated with increased postoperative complications and increased length of stay.

Methods

The Nationwide Readmissions Database was queried to identify patients undergoing elective primary TSA in 2021. A total of 1032 patients were identified with a prior history of COVID-19 infection within the 6 months before TSA. Prior COVID-19 patients were propensity score matched 1:1 on age, sex, Charlson-Deyo Comorbidity Index, and discharge weight to patients without a prior diagnosis of COVID-19 who underwent elective primary TSA in 2021. Demographic information, preoperative comorbidities, postoperative complications, and health-care resource utilization was compared between prior COVID-19 patients and controls. Binary logistic regression was used to identify independent predictors of complications.

Results

Prior COVID-19 patients had higher rates of in-hospital postoperative complications than control patients (P < .001). Prior COVID-19 patients had higher rates of specific complications than control patients, including débridement (P = .031), periprosthetic joint infection (PJI) (P < .001), acute respiratory distress syndrome (P < .001), acute renal failure (ARF) (P < .001), pulmonary embolism (P < .001), sepsis (P = .002), and urinary tract infection (P = .039). Following logistic regression analysis, history of a COVID-19 diagnosis was shown to be independently predictive of any in-hospital complication (P < .001), PJI (P = .006), and ARF (P < .001). Prior COVID-19 patients were found to have a longer hospital length of stay than controls (2.6 vs. 2.0; P < .001) but had similar total health-care costs ($77,426 vs. $74,912, P = .385).

Discussion

There is an increased risk of medical (acute respiratory distress syndrome, ARF, pulmonary embolism, sepsis, urinary tract infection) and surgical (PJI) complications following elective TSA in patients with COVID-19 infection less than 6 months before the TSA. These findings highlight the importance of preoperative risk assessment and counseling for this patient population. Potential risk mitigation strategies may include venous thromboembolic prophylaxis, postoperative antibiotics, and early medical comanagement.

新冠肺炎大流行严重扰乱了全肩关节置换术（TSA）等选择性骨科手术。最近的研究表明，最近诊断为COVID-19的患者在进行选择性骨科手术后出现并发症的风险增加。然而，缺乏专门针对TSA的类似研究。本研究的目的是确定原发性选择性TSA术前6个月内的COVID-19感染是否与术后并发症的增加和住院时间的增加有关。方法查询全国再入院数据库，以确定2021年接受选择性原发性TSA的患者。共有1032例患者在TSA前6个月内有COVID-19感染史。先前的COVID-19患者在年龄、性别、Charlson-Deyo合并症指数和出院体重方面的倾向评分匹配为1:1，这些患者之前没有诊断过COVID-19，并在2021年接受了选择性原发性TSA。比较既往COVID-19患者和对照组的人口统计信息、术前合并症、术后并发症和卫生保健资源利用情况。采用二元逻辑回归来确定并发症的独立预测因素。结果既往COVID-19患者术后院内并发症发生率高于对照组(P <；措施)。先前的COVID-19患者比对照组患者有更高的特定并发症发生率，包括假体周围关节感染（P = 0.031）、假体周围关节感染(P <；.001)，急性呼吸窘迫综合征(P <；.001)，急性肾功能衰竭（ARF） (P <；.001)，肺栓塞(P <；.001)、脓毒症（P = .002）和尿路感染（P = .039）。经logistic回归分析，COVID-19诊断史可独立预测任何院内并发症(P <；.001)、PJI （P = .006）和ARF (P <；措施)。先前的COVID-19患者的住院时间比对照组更长(2.6 vs. 2.0；P & lt;.001)，但医疗保健总成本相似（77,426美元对74,912美元，P = .385）。在TSA前不到6个月的COVID-19感染患者进行选择性TSA后，医疗（急性呼吸窘迫综合征、ARF、肺栓塞、败血症、尿路感染）和手术（PJI）并发症的风险增加。这些发现强调了术前风险评估和咨询对这类患者人群的重要性。潜在的风险缓解策略可能包括静脉血栓栓塞预防、术后抗生素和早期医疗管理。

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引用次数: 0

Improved patient outcomes and range of motion following primary and revision reverse total shoulder arthroplasty utilizing a custom glenoid implant for glenoid deficiency 使用定制的肩胛盂植入物治疗肩胛盂缺乏症，改善患者的预后和活动范围

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2025-04-20 DOI: 10.1053/j.sart.2025.03.008

Spencer M. Comfort MD , Lucas J. Ray MD , Jonathan D. Harley BA , Rebekah M. Kleinsmith MD , Haley D. Puckett MD , Jonathan P. Braman MD , Alicia K. Harrison MD , Allison J. Rao MD

Background

Glenoid bone loss in the primary and revision setting of reverse total shoulder arthroplasty (rTSA) creates the challenge of sufficient glenoid component positioning and fixation and is at risk of early mechanical failure and aseptic baseplate loosening. The purpose of this study was to evaluate clinical outcomes of primary and revision rTSA utilizing a custom glenoid implant for treatment of glenoid bone deficiency.

Methods

Patients who underwent rTSA with a Comprehensive Vault Reconstruction System (VRS) (Zimmer Biomet, Warsaw, IN, USA) custom glenoid implant in the primary or revision setting performed by 2 orthopedic surgeons between April 2016 and October 2023 were included. Demographic, prior surgical history, preoperative assessment, radiographic parameters, intraoperative procedures, and complication data were collected. Preoperative and postoperative range of motion and Single Assessment Numeric Evaluation (SANE) scores were compared and minimal clinically important difference was calculated for shoulder forward flexion (aFF), shoulder external rotation (aER), and SANE scores.

Results

Fifty-two shoulders (50 patients) met the inclusion criteria with 49 shoulders (47 patients) (94%) completing follow-up at mean 15.3 ± 21.0 months (range: 3-91 months). Mean age was 67 ± 13 with 25 females (51%). There were 16 (33%) primary and 33 (67%) revision rTSAs. There was significant improvement from preoperative to postoperative aFF (n = 45, 79 ± 35 to 118 ± 36, P < .001), aER (n = 42, 18 ± 24 to 29 ± 21, P = .02), and SANE score (n = 34, 32 ± 22 to 69 ± 23, P < .001). Minimal clinically important difference was calculated to be 69% for aFF, 67% for aER, and 79% for SANE. Two shoulders (4%) required revision surgery.

Conclusion

At mean follow-up of 15.3 months, rTSA with VRS custom glenoid implants for the treatment of glenoid bone deficiency in the primary and revision setting demonstrated improved patient-reported-outcomes and range of motion with low complication rate.

背景：在逆行全肩关节置换术（rTSA）的初次和翻修中，盂骨丢失给盂内假体的充分定位和固定带来了挑战，并且存在早期机械故障和无菌性底板松动的风险。本研究的目的是评估使用定制的关节盂植入物治疗关节盂骨缺乏的初次和改进型rTSA的临床结果。方法纳入2016年4月至2023年10月期间由2名骨科医生在初始或翻修环境中使用综合拱顶重建系统（VRS）（Zimmer Biomet, Warsaw， IN， USA）定制肩关节假体进行rTSA的患者。收集了人口统计学、既往手术史、术前评估、影像学参数、术中程序和并发症数据。比较术前和术后活动范围和单一评估数值评估（SANE）评分，计算肩关节前屈（aFF）、肩关节外旋（aER）和SANE评分的最小临床重要差异。结果52例肩（50例）符合纳入标准，49例肩（47例）（94%）完成随访，平均15.3±21.0个月（范围：3-91个月）。平均年龄67±13岁，女性25例（51%）。16例（33%）为原发性rtsa， 33例（67%）为修订rtsa。术前至术后aFF有显著改善(n = 45, 79±35至118±36，P <；.001)、aER评分（n = 42, 18±24 ~ 29±21,P = 0.02）、SANE评分(n = 34, 32±22 ~ 69±23,P <；措施)。计算出af的最小临床重要差异为69%，aER为67%，SANE为79%。两肩（4%）需要翻修手术。结论在平均15.3个月的随访中，rTSA与VRS定制肩关节假体治疗肩关节骨缺乏症在初次和翻修时显示出改善患者报告的结果和活动范围，并发症发生率低。

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引用次数: 0

Reported outcome measures in total elbow arthroplasty: a systematic review 全肘关节置换术的报道结果：一项系统回顾

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2025-04-20 DOI: 10.1053/j.sart.2025.03.007

Timothy R. Buchanan BS , Chris B. Lamprecht BS , Victoria E. Bindi BS , Oluwaferanmi T. Dada BS , Michael Guyot BS , Andrew H.A. Kaiser BS , Robert J. Cueto BS , Keegan M. Hones MD, MS , Jonathan O. Wright MD , Thomas W. Wright MD , Joseph J. King MD , Kevin A. Hao MD

Background

Total elbow arthroplasty (TEA) outcomes are historically modest with high rates of complications. While many studies have explored means of improving TEA outcomes, lack of standardization of outcome measures has made cross-study comparison difficult. This systematic review aims to characterize patient-reported outcome measures (PROMs), elbow range of motion (ROM), strength, and complications across the TEA literature.

Methods

We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify clinical studies on TEA from 1969 to 2023. Studies were excluded if they lacked clinical outcomes or included allograft prosthetic composites, hemiarthroplasties, or oncologic indications for TEA.

Results

We included 271 articles reporting on 23,005 elbows (21,665 patients) that underwent TEA (median age 62 years, 41% female, and median follow-up of 58 months). PROMs were reported by 60% (n = 161) of studies. The most common of the 15 identified PROMs was the Mayo Elbow Performance Score (89%, n = 144) followed by the visual analog scale for pain (15%, n = 24); Disabilities of Arm, Shoulder, and Hand score (12%, n = 20); Quick Disabilities of Arm, Shoulder, and Hand score (8%, n = 13); and Oxford Elbow score (7%, n = 11). The number of PROMs reported per study increased over time (P < .001) and decreased with increasing cohort size (P = .004). Elbow ROM was reported by 82% (n = 223) of studies; arm strength was reported by 4% (n = 11) of studies, and complications were reported in 92% (n = 250) of studies.

Conclusion

Significant heterogeneity exists in the reporting of outcome measures in the TEA literature. To facilitate future cross-study comparison, we recommend reporting of at least the Mayo Elbow Performance Score, visual analog scale for pain, elbow ROM (flexion, extension, pronation, and supination), and elbow strength via objective elbow extension measurements.

历史上，全肘关节置换术（TEA）的预后一般，并发症发生率高。虽然许多研究探索了改善TEA结果的方法，但结果测量缺乏标准化，使得交叉研究比较变得困难。本系统综述旨在描述TEA文献中患者报告的结果测量（PROMs）、肘关节活动范围（ROM）、力量和并发症。方法：我们使用系统评价和荟萃分析指南的首选报告项目进行系统评价。我们查询了PubMed/MEDLINE、Embase、Web of Science和Cochrane数据库，以确定1969年至2023年TEA的临床研究。如果缺乏临床结果或包含同种异体假体复合材料、半关节置换术或肿瘤适应症的研究被排除。结果：我们纳入了271篇文章，报道了23005例肘部（21665例患者）接受TEA治疗（中位年龄62岁，41%为女性，中位随访58个月）。60% （n = 161）的研究报告了PROMs。在确定的15种PROMs中，最常见的是Mayo肘部表现评分（89%,n = 144），其次是疼痛视觉模拟量表（15%,n = 24）；手臂、肩部和手部残疾评分（12%,n = 20）；手臂、肩部和手部快速残疾评分（8%,n = 13）；牛津肘评分（7%,n = 11）。每次研究报告的prom数量随时间而增加(P <；.001)，并随着队列规模的增加而下降（P = .004）。82% （n = 223）的研究报告肘部ROM；4% （n = 11）的研究报告了臂力，92% （n = 250）的研究报告了并发症。结论TEA文献中结果测量的报告存在显著的异质性。为了便于将来的交叉研究比较，我们建议至少报告Mayo肘关节表现评分、疼痛视觉模拟量表、肘关节活动度（屈曲、伸展、旋前和旋后）以及通过客观肘关节伸展测量得出的肘关节力量。

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引用次数: 0

Outcomes of reverse shoulder arthroplasty in patients with os acromiale: a systematic review 肩峰性骨质疏松患者的反向肩关节置换术的疗效：一项系统综述

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2025-04-03 DOI: 10.1053/j.sart.2025.03.004

Gregorio Secci MD , Mark Mouchantaf MD , Philipp Schippers MD , Manon Biegun MD , Luigi Zanna MD , Matteo Innocenti MD , Raffaele Tucci MD , Pascal Boileau MD, PhD

Background

When the acromion does not fully fuse during development, the resulting condition is known as os acromiale. Since the deltoid muscle, a key player in reverse shoulder arthroplasty (RSA), attaches to the acromion, surgeons may be hesitant to implant an RSA in these patients. Hence, the aim of this study is to report the clinical and radiological outcomes, as well as safety and effectiveness of RSA in patients with os acromiale.

Methods

A systematic review of the literature was conducted to evaluate the outcomes of RSA in patients with os acromiale, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four studies with a total of 100 patients (103 shoulders) were reviewed. Data on clinical outcomes, range of motion, pain relief, and complications were reported.

Results

Patients with os acromiale undergoing RSA showed significant improvements in clinical outcomes. The mean weighted postoperative Constant-Murley score was 69 points, with improved range of motion. In 38.8% of cases, a postoperative acromial tilt was reported; however, this did not significantly affect the outcome.

Conclusions

RSA can be considered a safe and reliable procedure for patients with os acromiale, offering improvements in both pain and function, similar to those observed in patients without os acromiale. More than one-third of patients (38.8%) experience os acromiale tilting, which did not show clinical relevance.

当肩峰在发育过程中没有完全融合时，产生的情况被称为肩峰畸形。由于三角肌是反向肩关节置换术（RSA）的关键部位，它附着于肩峰，外科医生可能会对在这些患者中植入RSA犹豫不决。因此，本研究的目的是报告RSA治疗肩峰性骨质疏松患者的临床和放射学结果，以及安全性和有效性。方法根据系统评价和荟萃分析指南的首选报告项目，对文献进行了系统回顾，以评估肩峰性骨质疏松患者的RSA结果。我们回顾了4项共100例患者（103个肩关节）的研究。报告了临床结果、活动范围、疼痛缓解和并发症的数据。结果肩峰性骨质疏松患者行RSA治疗后临床疗效明显改善。术后平均加权Constant-Murley评分为69分，活动范围改善。38.8%的病例术后出现肩峰倾斜；然而，这并没有显著影响结果。结论srsa对于肩峰性骨骼肌患者是一种安全可靠的治疗方法，与无肩峰性骨骼肌患者相比，其疼痛和功能都得到了改善。超过三分之一的患者（38.8%）出现肩峰倾斜，无临床相关性。

{"title":"Outcomes of reverse shoulder arthroplasty in patients with os acromiale: a systematic review","authors":"Gregorio Secci MD , Mark Mouchantaf MD , Philipp Schippers MD , Manon Biegun MD , Luigi Zanna MD , Matteo Innocenti MD , Raffaele Tucci MD , Pascal Boileau MD, PhD","doi":"10.1053/j.sart.2025.03.004","DOIUrl":"10.1053/j.sart.2025.03.004","url":null,"abstract":"<div><h3>Background</h3><div>When the acromion does not fully fuse during development, the resulting condition is known as os acromiale. Since the deltoid muscle, a key player in reverse shoulder arthroplasty (RSA), attaches to the acromion, surgeons may be hesitant to implant an RSA in these patients. Hence, the aim of this study is to report the clinical and radiological outcomes, as well as safety and effectiveness of RSA in patients with os acromiale.</div></div><div><h3>Methods</h3><div>A systematic review of the literature was conducted to evaluate the outcomes of RSA in patients with os acromiale, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four studies with a total of 100 patients (103 shoulders) were reviewed. Data on clinical outcomes, range of motion, pain relief, and complications were reported.</div></div><div><h3>Results</h3><div>Patients with os acromiale undergoing RSA showed significant improvements in clinical outcomes. The mean weighted postoperative Constant-Murley score was 69 points, with improved range of motion. In 38.8% of cases, a postoperative acromial tilt was reported; however, this did not significantly affect the outcome.</div></div><div><h3>Conclusions</h3><div>RSA can be considered a safe and reliable procedure for patients with os acromiale, offering improvements in both pain and function, similar to those observed in patients without os acromiale. More than one-third of patients (38.8%) experience os acromiale tilting, which did not show clinical relevance.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"35 3","pages":"Pages 387-396"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Risk factors for periprosthetic fractures following total shoulder arthroplasty in patients younger than 50 years of age 年龄小于50岁的患者全肩关节置换术后假体周围骨折的危险因素

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2025-04-03 DOI: 10.1053/j.sart.2025.03.003

Eric Cui BS , Andrew Fealy BS , Jackson W. Durbin BS , Philip M. Parel BS , Seyedeh Zahra Mousavi BS , Amil R. Agarwal MD , Ami Kapadia MD , Theodore Quan MD , Sabrina Gill MD , Rachel Ranson DO , Zachary R. Zimmer MD , Uma Srikumaran MD, MBA, MPH

Background

The rise of total shoulder arthroplasties (TSAs) has led to a concomitant increase in the incidence of periprosthetic fractures (PPFs). The treatment of PPF remains a technical challenge for orthopedic surgeons, as surgical management can lengthen recovery time and cause secondary complications, including potential nonunion, implant failure, and neurovascular injury. Prior studies investigated risk factors associated with PPFs following TSA in patients over the age of 60. To date, no studies have exclusively examined the potential risk factors for PPF in patients under the age of 50. Therefore, the purpose of this study was to investigate these potential risk factors for PPF following TSA in patients under the age of 50.

Methods

Patients who underwent primary TSA with subsequent postoperative PPF within 2 years of surgery were identified using a national claims database. Patients were stratified into 5 age cohorts as follows: under 20, 20-30, 30-40, 40-50, and 50-60 years of age. Baseline demographics between the study cohorts were compared using Pearson’s chi-squared test and Student t-tests, where appropriate. Multivariate logistic regression analysis was utilized to observe significant differences in risk factors for 2-year PPFs using the age 50-60 cohort as a reference with the output recorded as the odds ratios (OR), 95% confidence intervals (95% confidence interval), and the P value. A P value less than .05 was used as the significance level for this study.

Results

Risk factors for increased 2-year PPFs included neurological disease (OR: 1.97), chronic kidney disease (OR: 1.51), drug abuse (OR: 2.38), and prior shoulder trauma (OR: 3.45) compared to the age 50-60 cohort (P < .05 for all). Protective factors included shoulder osteoarthritis (OR: 0.72) and male sex (OR: 0.43) for the risk of PPF (P < .05 for all).

Conclusion

This study identified several risk factors associated with increased incidence of PPFs within 2 years following TSA in patients under the age of 50, including neurological disease, chronic kidney disease, drug abuse, and prior shoulder trauma. Of note, shoulder osteoarthritis and male sex were protective factors against early PPF. The findings highlight the importance of evaluating younger TSA patients for these risk factors preoperatively. Modifiable risks such as drug abuse should be addressed, while nonmodifiable risks may warrant closer follow-up or surgical technique adjustments. Overall, this risk stratification can guide surgeons in counseling younger patients and optimizing outcomes following surgery.

背景：全肩关节置换术（tsa）的增加导致假体周围骨折（PPFs）的发生率增加。对于骨科医生来说，治疗PPF仍然是一个技术挑战，因为手术治疗会延长恢复时间并引起继发性并发症，包括潜在的骨不连、植入物失败和神经血管损伤。先前的研究调查了60岁以上患者TSA后ppf相关的危险因素。迄今为止，还没有专门研究50岁以下患者PPF的潜在危险因素。因此，本研究的目的是调查50岁以下患者TSA后PPF的潜在危险因素。方法使用国家索赔数据库确定在2年内接受原发性TSA并随后术后PPF的患者。患者分为5个年龄组：20岁以下、20-30岁、30-40岁、40-50岁和50-60岁。在适当的情况下，使用Pearson卡方检验和学生t检验比较研究队列之间的基线人口统计学特征。采用多因素logistic回归分析，以50-60岁队列为参照，观察2年PPFs的危险因素存在显著差异，输出记录为比值比（OR）、95%置信区间（95%置信区间）和P值。采用P < 0.05作为本研究的显著性水平。结果与50-60岁队列相比，2年PPFs增加的危险因素包括神经系统疾病（OR: 1.97）、慢性肾脏疾病（OR: 1.51）、药物滥用（OR: 2.38）和既往肩部创伤（OR: 3.45） (P <；0.05)。预防PPF的因素包括肩骨关节炎（OR: 0.72）和男性（OR: 0.43）。0.05)。结论：本研究确定了与50岁以下患者TSA后2年内PPFs发生率增加相关的几个危险因素，包括神经系统疾病、慢性肾脏疾病、药物滥用和既往肩部创伤。值得注意的是，肩关节骨关节炎和男性是早期PPF的保护因素。研究结果强调了术前评估年轻TSA患者这些危险因素的重要性。可改变的风险如药物滥用应予以处理，而不可改变的风险可能需要更密切的随访或手术技术调整。总的来说，这种风险分层可以指导外科医生对年轻患者进行咨询，并优化手术后的结果。

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引用次数: 0

Acromion and scapular spine fractures following reverse total shoulder arthroplasty: operative versus nonoperative management 肩峰和肩胛骨骨折后的反向全肩关节置换术：手术与非手术治疗

Q4 Medicine

Seminars in Arthroplasty

Pub Date : 2025-03-28 DOI: 10.1053/j.sart.2025.03.001

John W. Moore BS, Robert Reis BS, Megan E. Welsh BS, Brandon L. Rogalski MD, Richard J. Friedman MD, FRCSC, Josef K. Eichinger MD

<div><h3>Background</h3><div>The reported incidence of acromial and scapular spine fractures (ASFs) following reverse total shoulder arthroplasty (rTSA) is approximately 5%. There is no consensus on whether to treat ASFs operatively or nonoperatively. This study reviewed patients diagnosed with ASFs following rTSA to determine which patients are successfully managed nonoperatively versus those who undergo surgery. We hypothesized that nonoperative and operative treatment results in equivalent outcomes.</div></div><div><h3>Methods</h3><div>A database of prospectively enrolled patients was reviewed to identify patients who underwent rTSA and were diagnosed with a postoperative ASF from 2015 to 2022 with a minimum 2-year follow-up (n = 19). Nonoperative treatment was initially attempted on all patients. Patients were separated into operative (n = 7) and nonoperative (n = 12) groups based on treatment. Demographic information and clinical outcomes were compared between patients. ASF patients were then matched 1:1 to a group of nonfracture rTSA patients on age (±12 months), sex, body mass index (±2.0), follow-up duration (±6 months), and whether the dominant arm was affected, yielding an ASF group (n = 19) and a nonfracture control group (n = 19). Demographic information and clinical outcomes at last follow-up were compared between groups. Clinical outcomes included American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value, Visual Analog Scale (VAS) pain, and range of motion (ROM).</div></div><div><h3>Results</h3><div>Patients with Levy type I fractures were more likely to be treated operatively (71.4% vs. 8.3%; <em>P</em> = .013). Patients with Levy type I fractures had higher VAS pain scores than those with type II or III fractures (4.7 vs. 1.8 vs. 1.0; <em>P</em> = .014). Patients with fractures lateral to the glenoid articular surface had lower ASES scores (57.7 vs. 71.8; <em>P</em> = .05) and higher VAS pain scores (3.7 vs. 1.2; <em>P</em> = .009) than patients with nonlateral ASFs. Regardless of operative or nonoperative treatment, ASF patients had lower ASES scores (64.3 vs. 88.2; <em>P</em> < .001), lower Subjective Shoulder Values (69.0 vs. 85.8; <em>P</em> < .001), and higher VAS pain scores (2.5 vs. 0.8; <em>P</em> = .007) compared to nonfracture controls. ASF patients had inferior ROM, including less flexion/extension, (131 vs. 156; <em>P</em> < .001), less external rotation (46 vs. 58; <em>P</em> = .024), and lower internal rotation scores (4.7 vs. 5.9; <em>P</em> < .001) than nonfracture controls.</div></div><div><h3>Conclusion</h3><div>The development of ASFs, regardless of treatment modality, was associated with inferior outcomes and ROM compared to nonfracture rTSA patients. Type I fractures were more likely to fail nonoperative treatment than medial fractures. Lateral fractures had inferior outcomes compared to medial fractures. Fall prevention and adequate lifting restrictions may significantly lower t

据报道，逆行全肩关节置换术（rTSA）后肩峰和肩胛骨骨折（ASFs）的发生率约为5%。对于asf是手术治疗还是非手术治疗尚无共识。本研究回顾了经rTSA诊断为asf的患者，以确定哪些患者非手术治疗成功，哪些患者接受手术治疗成功。我们假设非手术和手术治疗的结果相同。方法回顾前瞻性入选患者的数据库，以确定2015年至2022年期间接受rTSA并被诊断为术后ASF的患者，并进行至少2年的随访（n = 19）。所有患者最初都尝试非手术治疗。根据治疗情况将患者分为手术组（n = 7）和非手术组（n = 12）。比较两组患者的人口学信息和临床结果。然后根据年龄（±12个月）、性别、体重指数（±2.0）、随访时间（±6个月）以及优势臂是否受到影响，将ASF患者与非骨折rTSA患者进行1:1匹配，形成ASF组（n = 19）和非骨折对照组（n = 19）。比较两组患者最后随访时的人口学信息和临床结果。临床结果包括美国肩关节外科医生评分、主观肩值、视觉模拟评分（VAS）疼痛和活动范围（ROM）。结果Levy I型骨折患者接受手术治疗的可能性更高(71.4% vs 8.3%；P = .013)。Levy I型骨折患者的VAS疼痛评分高于II型或III型骨折患者(4.7比1.8比1.0；P = .014)。肩关节面外侧骨折患者的as评分较低(57.7比71.8；P = 0.05)和更高的VAS疼痛评分(3.7 vs. 1.2；P = 0.009)。无论手术或非手术治疗，ASF患者的as评分较低(64.3比88.2；P & lt;.001)，主观肩值较低(69.0比85.8；P & lt;.001)， VAS疼痛评分较高(2.5 vs. 0.8；P = .007)。ASF患者的活动度较差，包括屈伸较少(131 vs 156；P & lt;.001)，较少的外旋(46 vs. 58；P = 0.024)，内旋评分较低(4.7 vs. 5.9；P & lt;.001)。结论与非骨折rTSA患者相比，asf的发展，无论治疗方式如何，与较差的预后和ROM相关。I型骨折的非手术治疗比内侧骨折更容易失败。与内侧骨折相比，外侧骨折的预后较差。预防跌倒和适当的举重限制可以显著降低非洲猪瘟的发病率。

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引用次数: 0