Seminars in Arthroplasty最新文献

{"title":"Maximum of 10-year surgical outcomes following reverse total shoulder arthroplasty for rotator cuff arthropathy vs. proximal humerus fractures","authors":"Eric Cui BS ,&nbsp;Daniel Raftis BS ,&nbsp;Jackson W. Durbin BS ,&nbsp;Andrew Fealy BS ,&nbsp;Philip M. Parel BS ,&nbsp;Rachel Ranson DO ,&nbsp;Alana O'Mara MA ,&nbsp;Theodore Quan MD ,&nbsp;Jacob D. Mikula MD ,&nbsp;Ashish Vankara MD ,&nbsp;Zachary Zimmer MD ,&nbsp;Uma Srikumaran MD, MBA, MPH","doi":"10.1016/j.sart.2025.151527","DOIUrl":"10.1016/j.sart.2025.151527","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) in the setting of rotator cuff arthropathy (RCA) is an elective procedure in response to a chronic and degenerative process that occurs only after thorough preoperative risk stratification and adequate patient optimization. In contrast, rTSA secondary to proximal humerus fracture (PHF) is a response to an acute traumatic injury that frequently occurs in elderly patients with underlying comorbidities such as osteoporosis. These distinct patient populations may have unique risk profiles that could influence the long-term survivorship of implants and the specific indications for revision surgery. Despite the widespread use of rTSA for both RCA and PHF, the comparative long-term outcomes, revision rates, and indications for revision between these 2 patient populations are not well established.</div></div><div><h3>Methods</h3><div>Patients who underwent primary rTSA were identified using Current Procedural Terminology and International Classification of Diseases codes from a national claims database and stratified into PHF and RCA cohorts. Patients were included if they had at least two years of postoperative data. These cohorts were propensity score matched by age, gender, and Charlson Comorbidity Index to control for potential confounders. The 10-year and 5-year cumulative incidence rate and risk of all-cause revision, periprosthetic fracture (PPF), periprosthetic joint infection (PJI), dislocation, and mechanical loosening were determined using Kaplan-Meier and Cox proportional hazard analyses.</div></div><div><h3>Results</h3><div>In total, 23,684 patients were included in this study, with 7,982 patients (33.70%) and 15,702 patients (66.30%) included in the PHF and RCA cohort, respectively. The 10-year cumulative risk for all-cause revision (hazard ratio [HR]: 1.5; <em>P</em> &lt; .001), PPF (HR: 1.7; <em>P</em> &lt; .001), dislocation (HR: 1.7; <em>P</em> &lt; .001), and PJI (HR: 1.31; <em>P</em> = .001) were all significantly higher in the PHF cohort compared to the RCA cohort. Similarly, at the 5-year mark, the risk of all-cause revision (HR: 1.6; <em>P</em> &lt; .001), PPF (HR: 1.6; <em>P</em> &lt; .001), dislocation (HR: 1.7; <em>P</em> &lt; .001), and PJI (HR: 1.3; <em>P</em> = .002) was also significantly higher in the PHF cohort. In contrast, mechanical loosening did not differ significantly between groups at both the 5-year and 10-year marks.</div></div><div><h3>Conclusion</h3><div>Over a 10-year period, patients undergoing rTSA for PHF demonstrated a higher risk of all-cause revision, PPF, dislocation, and PJI. These findings highlight the importance of counseling patients about the likely long-term outcomes following an rTSA for PHF compared to elective RCA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151527"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of glenosphere size on outcomes and complications associated with reverse shoulder arthroplasty: a systematic review and meta-analysis","authors":"Thomas A. Deane MD, MB, BCh, BAO ,&nbsp;Andrew J. Kelly MD, MB, BCh, BAO ,&nbsp;Conor McNamee MD, MB, BCh, BAO ,&nbsp;James G. Kelly MD, MB, BCh, BAO ,&nbsp;Stefan Bauer MD, MB, BCh, BAO ,&nbsp;William G. Blakeney MBBS, MS, MSc, FRACS","doi":"10.1016/j.sart.2025.151525","DOIUrl":"10.1016/j.sart.2025.151525","url":null,"abstract":"<div><h3>Background</h3><div>Glenosphere diameter is a variable component in different reverse shoulder arthroplasty designs. The size of the glenosphere influences the amount of glenosphere overhang. Computer and cadaveric models have postulated that increased glenosphere overhang may restore better range of motion and decrease complications including scapular notching. Alternatively, it has been postulated that increasing glenosphere size may increase tension on the posterior capsule and reduce internal rotation. There is conflicting evidence in the literature regarding the clinical outcomes of increased glenosphere size.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using search engines in PubMed, EMBASE, and Cochrane to retrieve all relevant studies. The Cochrane Risk of Bias Assessment Tool 2 (RoB-2) and risk of Bias in Non-Randomized trials were used to assess for bias. We present log risk ratios for dichotomous variables and raw mean differences (MDs) for continuous variables. The large glenosphere group was defined as ≥40 mm while the small glenosphere group was defined as ≤39 mm.</div></div><div><h3>Results</h3><div>Five studies were included in the quantitative meta-analysis conducted in this paper, comparing 1,217 shoulders. Results of the primary outcomes when comparing large to small glenosphere were as follows: abduction (MD: 0.52; 95% confidence interval [CI]: −5.90, 4.86), forward flexion (MD: 2.38; 95% CI: −1.37, 6.13), external rotation (MD: 2.9; 95% CI: −1.96, 7.76), Constant-Murley Score (MD: 0.49, 95% CI: −2.79, 3.78), American Shoulder and Elbow Surgeons (MD: 3.23; 95% CI: 0.92, 5.54), and scapular notching (odds ratio: −0.07; 95% CI: −0.2, 0.06).</div></div><div><h3>Conclusion</h3><div>The use of larger glenosphere sizes may not have any effect on range of motion or scapular notching. There is a statistically significant improvement in ASES scores, which is below the Minimal Clinically Important Difference.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151525"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926415","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":"Long-term clinical and radiographic outcomes following shoulder hemiarthroplasty","authors":"William A. Ranson MD,&nbsp;Evan M. Michaelson MD,&nbsp;Akiro H. Duey MD,&nbsp;Akshar V. Patel MD,&nbsp;Evan L. Flatow MD,&nbsp;Dave R. Shukla MD,&nbsp;Paul J. Cagle MD","doi":"10.1016/j.sart.2025.151526","DOIUrl":"10.1016/j.sart.2025.151526","url":null,"abstract":"<div><h3>Background</h3><div>The utilization of shoulder hemiarthroplasty (HA) has decreased in recent decades, with glenoid erosion being a main concern. Existing long-term follow-up studies involve a limited diversity of early implants and lack a thorough assessment of the effects of glenoid erosion on patient outcomes. This study sought to report the long-term survivorship of HA in patients treated with a variety of implants, the vast majority being of design generations subsequent to the early monoblock prostheses. An additional aim of this study was to characterize the incidence and severity of glenoid erosion and to elucidate the effects on patient outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review of prospectively collected data was performed on a consecutive series of HAs performed by a single surgeon between 1994 and 2012. Thirty-five shoulders met the inclusion criteria. In the primary analysis, shoulders were split into 2 cohorts based on whether or not they required revision surgery. A survivorship curve was plotted and the characteristics of the cohorts compared. In the secondary analysis, patients were split into 3 cohorts based on final glenoid erosion severity. Visual analog scale, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores, as well as range of motion, were then compared between the erosion cohorts.</div></div><div><h3>Results</h3><div>Seven of 35 shoulders (20.0%) underwent revision at an average of 9.3 years postoperatively, while 28 shoulders (80.0%) did not require revision at an average final follow-up of 15.3 years. The estimated 15-year survival rate was 83.0%. Glenoid erosion occurred in 26 (73.4%) shoulders and symptomatic glenoid erosion accounted for 4 of 7 (57.1%) revisions. Severity of glenoid erosion was not associated with differences in visual analog scale (<em>P</em> = .54), American Shoulder and Elbow Surgeons (<em>P</em> = .75), or Simple Shoulder Test (<em>P</em> = .77) scores. The development of severe glenoid wear was independently associated with decreased forward elevation (<em>P</em> = .03), external rotation (<em>P</em> &lt; .01), and internal rotation (IR) (<em>P</em> &lt; .01). The development of mild glenoid erosion trended toward an association with inferior IR (<em>P</em> = .06).</div></div><div><h3>Conclusion</h3><div>HA remains a viable option for the management of various shoulder pathologies with an estimated 15-year survival rate of 83.0%. Progressive glenoid erosion was present radiographically in 73.4% of patients at an average of 15.3 years postoperatively. Symptomatic glenoid wear accounted for over half of HA revisions. The development of severe glenoid wear was independently predictive of decreased range of motion in all planes. IR was particularly sensitive to erosive change, trending toward decreased motion with mild glenoid wear.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151526"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885142","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":"Efficacy and safety of the new Mirror anatomic total shoulder system: a preliminary report of a prospective multicentric trial","authors":"Kutalmiş Albayrak MD ,&nbsp;Matthias Zumstein MD ,&nbsp;Christophe Monnin MD ,&nbsp;Vilijam Zdravkovic MD ,&nbsp;Bernhard Jost MD","doi":"10.1016/j.sart.2025.151524","DOIUrl":"10.1016/j.sart.2025.151524","url":null,"abstract":"<div><h3>Background</h3><div>Anatomic total shoulder arthroplasty (aTSA) is a highly effective therapy for patients with glenohumeral arthritis and an intact rotator cuff. However, implant failure due to progressive cuff pathology or loosening of the glenoid component is a well-established long-term complication. Therefore, a new prosthesis design has been developed to address these problems by “mirroring” the pairing materials improving longevity of the glenoid component and facilitating the potential conversion to reverse configuration by further design novelties. This proof-of-concept study reports on the safety and clinical efficacy of this novel Mirror anatomic total shoulder arthroplasty (Mirror aTSA) with preliminary, 1-year follow-up data.</div></div><div><h3>Methods</h3><div>This prospective study included patients who underwent Mirror aTSA for osteoarthritis at 2 centers between January 2022 and November 2023. All patients had a follow-up of at least 12 months.</div></div><div><h3>Results</h3><div>The study included 20 consecutive patients (median age: 69, range 29-89 years, 9 male and 11 female patients) with established shoulder osteoarthritis and a clinically/US/magnetic resonance imaging confirmed competent rotator cuff, who were operated on by 2 senior surgeons. The median follow-up was 14.2 months (range 12.1 to 26.4 months). The Constant score showed a significant improvement from a median of 49.1 points (range 24-69.7) preoperatively to a median of 81.8 points (range 69-96) at 12 months follow-up. Similarly, the Oxford Shoulder Score) and Subjective Shoulder Value also improved from 27 points (range 8–37) and 40% (range 10–75%) preoperatively to a median of 48 points (range 38–48) and 95% (range 40%–100%) postoperatively, respectively. No complications related to the procedure or prosthesis were observed.</div></div><div><h3>Conclusion</h3><div>This study confirms that the novel Mirror aTSA provides highly satisfactory clinical and radiological results at the 12-month follow-up. While long-term results are still pending, our preliminary clinical and radiological results are encouraging.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151524"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926463","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":"Cannabis use as a negative predictor of complications following total shoulder arthroplasty","authors":"Kathryn E. Grabowski BA ,&nbsp;Kenny Ling MD ,&nbsp;Edward D. Wang MD","doi":"10.1016/j.sart.2025.151521","DOIUrl":"10.1016/j.sart.2025.151521","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is increasingly performed to improve shoulder function, driven by demographic shifts and advances in surgical techniques. Simultaneously, cannabis use amongst adults is rising due to increased legalization and expanding medical indications. Studies report varying effects of cannabis use on postoperative outcomes after total knee arthroplasty, hip arthroplasty, and spine surgery, but data on its impact following TSA remain limited. Given the increasing demand for TSA and rising prevalence of cannabis use in the U.S., it is important to understand how cannabis use impacts postoperative complications following TSA. The purpose of this study was to analyze the relationship between cannabis use and adverse postoperative outcomes following TSA.</div></div><div><h3>Methods</h3><div>The TriNetX national database was queried for records of patients who underwent TSA between January 1st, 2010, and December 31st, 2024. Patient cohorts and outcomes were defined using International Classification for Disease, 10th edition diagnosis codes and Current Procedural Terminology codes. After 1:1 propensity score matching, the cannabis user and noncannabis user cohorts were analyzed for differences in major outcomes 90 days and 2 years following the procedure.</div></div><div><h3>Results</h3><div>A total of 75,574 patients were identified in TriNetX who underwent TSA from 2010 to 2024. Of these, 2,043 had concomitant cannabis use and 73,531 had no prior record of cannabis use. After 1:1 propensity score matching based on demographics and comorbidities, 2,042 patients in each cohort were directly compared for postoperative outcomes. Compared to noncannabis users, patients who used cannabis had a higher risk for chronic obstructive pulmonary disease exacerbation (odds ratio [OR] 2.07, 95% confidence interval [CI] 1.28-3.35; <em>P</em> = .003), acute kidney failure (OR 1.56, 95% CI 1.10-2.21; <em>P</em> = .012), and pneumonia (OR 1.85, 95% CI 1.17-2.92; <em>P</em> = .007) within 90 days of the procedure. Compared to patients who did not use cannabis, those who did had a higher risk for prosthesis loosening (OR 1.79, 95% CI 1.06-3.03; <em>P</em> = .028), opioid dependence or abuse (OR 2.01, 95% CI 1.15-3.53; <em>P</em> = .013), and infection and inflammatory reaction due to prosthesis (OR 1.55, 95% CI 1.01-2.19; <em>P</em> = .012) within 2 years.</div></div><div><h3>Conclusion</h3><div>Preoperative cannabis use was associated with several postoperative complications 90 days and 2 years following TSA. In the setting of increasing TSA utilization, preoperative patient counseling on cannabis cessation before TSA may be beneficial for postoperative outcomes.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151521"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037650","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":"Analysis of mechanical factors related to scapular notching and medial scapular bone spurs with reverse total shoulder arthroplasty and the reduction of their appearance with inferior glenosphere offset","authors":"Paul J. Pottanat MD,&nbsp;Robert Reis BS,&nbsp;Chase Walton MS,&nbsp;Nikhil Vallabhaneni BS,&nbsp;Megan E. Welsh BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC,&nbsp;Josef K. Eichinger MD","doi":"10.1016/j.sart.2025.151523","DOIUrl":"10.1016/j.sart.2025.151523","url":null,"abstract":"<div><h3>Background</h3><div>Scapular notching and bone spur formation on the inferior scapular neck is a common radiographic finding following reverse total shoulder arthroplasty (rTSA). The purpose of the current study is to (1) determine the time point these radiographic findings develop in the postoperative period and (2) determine the effect of inferior glenoid offset on the formation of notching and bone spurs following rTSA.</div></div><div><h3>Methods</h3><div>A shoulder arthroplasty registry with prospectively collected data was queried to identify patients who underwent rTSA using the Exatech Equinoxe implant at an academic medical center between June 2017 and June 2022. Postoperative radiographs were analyzed for the presence of scapular notching, scapular bone spurs, prosthetic loosening, periprosthetic fracture, and hardware failure. Bone spurs were defined as bone formation medial to the lateral border of the scapula and in continuity with the scapular neck which were not present on preoperative radiographs.</div></div><div><h3>Results</h3><div>In a cohort of 185 rTSA patients, radiographic analysis demonstrated that both scapular notching and medial scapular bone spurs predominantly developed early in the postoperative period, with most changes evident between 3 months and 6 months. Binary logistic regression demonstrated that increased inferior glenosphere offset significantly reduced the risk of scapular bone spurs (odds ratio = 0.79; 95% confidence interval: 0.70-0.88, <em>P</em> &lt; .001) and notching (odds ratio = 0.95, 95% confidence interval: 0.84-1.08 <em>P</em> &lt; .001), with offsets of ∼8.2 mm and ∼9.6 mm predicted less than 10% probability, respectively. Cross-lagged analysis showed a strong early correlation between bone spurs and notching (r = 0.876, R² = 0.767) and that early bone spur progression predicted subsequent increases in notch severity.</div></div><div><h3>Conclusion</h3><div>Early postoperative development of medial scapular bone spurs is predictive of subsequent scapular notching, which indicates a common pathomechanical process of engagement of the humeral component and medial scapula for both types of radiographic findings after rTSA. Increased inferior glenosphere positioning protects against both notching and bone spur formation.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151523"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977805","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":"Effect of race and socioeconomic status on the attainment of substantial clinical benefit following total shoulder arthroplasty","authors":"Jakob M. Miller BS,&nbsp;Sophia A. Sitsis BS,&nbsp;Robert T. Henke BS,&nbsp;Maxwell A. Northrop BS,&nbsp;Alexander C. Dippre BS,&nbsp;John W. Moore BS,&nbsp;Brandon L. Rogalski MD,&nbsp;Richard J. Friedman MD, FRCSC","doi":"10.1016/j.sart.2025.151522","DOIUrl":"10.1016/j.sart.2025.151522","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) is a procedure designed to improve mobility and alleviate pain due to degenerative conditions, and rates are expected to grow significantly in the coming years as the population ages. Previous studies provide ample evidence that factors such as race, income status, and gender influence utilization and outcomes following TSA. However, these studies fail to assess objective achievement of substantial clinical benefit (SCB) using verified outcome measures or whether patients report achievement of SCB. The purpose of this study is to identify whether race and socioeconomic status (SES) impact the attainment of SCB in patients undergoing primary TSA at a minimum follow-up of two years.</div></div><div><h3>Methods</h3><div>A total of 625 patients who underwent primary TSA with a minimum 2-year follow-up (mean, 4 years) at our institution from 2013 to 2023 were selected for analysis. Variables of interest obtained for each patient include age, sex, laterality, body mass index, race, area deprivation index decile, American Shoulder and Elbow Surgeons (ASES) scores, and self-reported patient satisfaction following TSA. Analysis of categorical variables was achieved using chi-squared tests, while continuous variables were examined using t-tests and one-way analysis of variance. Post hoc Tukey honest significant difference tests were used in the event of a significant result. Using the achievement of SCB as an outcome variable, multivariate logistic association models were created to adjust for confounding variables.</div></div><div><h3>Results</h3><div>Black race was found to be negatively associated with the achievement of SCB (odds ratio = 0.444, <em>P</em> = .018). Income category was not found to be associated with SCB attainment (<em>P</em> = .173). Preoperative ASES scores were found to be significantly lower for Black patients compared to White patients (36.40 vs. 24.48, <em>P</em> &lt; .001). Preoperative ASES scores were found to be significantly lower for the lowest income quartile compared to the 2 highest income quartiles (25.78 vs. 36.79 and 40.50, <em>P</em> &lt; .001). ASES score improvement was found to be significantly higher in the lowest quartile compared to the top quartile of earners (57.48 vs. 45.76, <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Black race was significantly associated with decreased attainment of SCB, while income status did not significantly affect SCB attainment. Despite lower preoperative ASES scores, Black and low SES patients showed similar ASES score improvements on average compared to White and high SES patients. These results highlight persistent disparities in health care access but suggest that low preoperative shoulder function does not preclude patients from improving, although they achieve SCB to a lesser degree.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151522"},"PeriodicalIF":0.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926409","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":"Patients 60 years old or younger have an increased risk of complications following reverse total shoulder arthroplasty: a propensity-score matched analysis","authors":"Argen Omurzakov BA ,&nbsp;Arsen M. Omurzakov BA ,&nbsp;Alexander E. White MD ,&nbsp;Aakash K. Shah BA ,&nbsp;Samuel A. Taylor MD ,&nbsp;John M. Apostolakos MD, MPH","doi":"10.1016/j.sart.2025.151519","DOIUrl":"10.1016/j.sart.2025.151519","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (rTSA) continues to be performed at increasing rates in younger patients. Further investigation is needed to further define the complication and risk profile for this younger patient population.</div></div><div><h3>Methods</h3><div>The TriNetX database was utilized to perform a retrospective analysis comparing younger (≤60 years) and older (&gt;60 years) patients undergoing rTSA. Patients were matched 1:1 using propensity scores to balance demographics and comorbidities. Outcomes assessed included 1-year, 2-year, and 5-year postoperative complications and revision rates. The Bonferroni adjusted significance threshold was set at <em>P</em> = .0166.</div></div><div><h3>Results</h3><div>At 1 year, younger patients experienced a significantly higher rate of recurrent dislocation (5.8% vs. 3.1%, risk ratio [RR] = 1.9, 95% confidence interval [CI] 1.3–2.7, <em>P</em> = .001), with no significant differences in periprosthetic joint infection (PJI; <em>P</em> = .040) or revision surgery (<em>P</em> = .033). At 2 years, recurrent dislocation remained higher in the younger cohort (6.4% vs. 3.8%, RR = 1.7, 95% CI 1.2–2.4, <em>P</em> = .003), while PJI (<em>P</em> = .107) and revision surgery (<em>P</em> = .025) rates showed no significant differences. At 5 years, both recurrent dislocation (8.9% vs. 5.8%, RR = 1.5, 95% CI 1.2–2.0, <em>P</em> = .003) and revision surgery (7.2% vs. 4.7%, RR = 1.5, 95% CI 1.1–2.1, <em>P</em> = .008) remained significantly higher in younger patients, whereas PJI rates were not significantly different (<em>P</em> = .075).</div></div><div><h3>Conclusion</h3><div>Patients aged 60 years and undergoing rTSA demonstrated significantly higher rates of recurrent dislocation and revision surgery compared to older patients. These findings suggest that younger patients maybe at greater risk of postoperative complications after rTSA.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151519"},"PeriodicalIF":0.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926408","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":"Does subscapularis tendon repair during primary reverse total shoulder replacement improve shoulder stability or functional outcomes: a systematic review and meta-analysis","authors":"Mohamed Elbeshbeshy MBChB,&nbsp;Rahel Rashid MBChB,&nbsp;Zaid Hashim MBBS,&nbsp;Abdaal Munir MBBS,&nbsp;Israa Kadhmawi MBChB,&nbsp;Conor Magee MBChB, MD,&nbsp;David Hawkes MBChB","doi":"10.1016/j.sart.2025.151520","DOIUrl":"10.1016/j.sart.2025.151520","url":null,"abstract":"<div><h3>Background</h3><div>The role of subscapularis tendon repair (STR) in reverse total shoulder arthroplasty (RTSA) continues to be debated. Proponents highlight the benefits as enhanced shoulder stability, greater internal rotation, and improved functional outcomes. Critics however argue it may limit external rotation and increase revision and complication rates. The aim of this review was to evaluate the impact of STR on shoulder stability and clinical outcomes in the context of primary RTSA.</div></div><div><h3>Methods</h3><div>A comprehensive search of PubMed, Embase, Web of Science, Scopus, and Cochrane Library databases was performed to identify studies comparing outcomes between patients undergoing primary RTSA with STR and those with no STR (nSTR). The primary outcome was shoulder instability. Secondary outcomes included functional scores (American Shoulder and Elbow Surgeons score, Constant-Murley Score, and visual analog scale), range of motion, revision rate, and complications. Meta-analysis was performed using a random-effects model, and heterogeneity was assessed using the I² statistic.</div></div><div><h3>Results</h3><div>A total of 19 studies met the inclusion criteria. One study had a critical risk of bias leading to its exclusion from the meta-analysis, resulting in the inclusion of the remaining 18 studies with 8,231 patients. STR was associated with a significantly lower risk of postoperative shoulder instability (RR 0.47, 95% confidence interval [CI] 0.28-0.81, I2 = 0%, <em>P</em> = .006), higher American Shoulder and Elbow Surgeons scores (mean difference = 3.47, 95% CI: 1.84-5.10, <em>P</em> &lt; .0001), Constant-Murley Score (mean difference = 2.43, 95% CI: 0.66-4.20, <em>P</em> = .006), and internal rotation scores (standardized mean difference = 0.46, 95% CI: 0.28-0.63, <em>P</em> = .0003). No significant differences were observed in visual analog scale scores, external rotation, revision rates, or overall complication rates between groups. Heterogeneity was accounted for by implementing random-effects models.</div></div><div><h3>Conclusion</h3><div>STR should be attempted during RTSA if feasible, as it potentially improves shoulder stability. However, the impact of STR on clinically-significant functional outcomes, range of motion, pain level, revision rates, and complications remains inconclusive. Further high-quality randomized controlled trials are needed to validate these findings. Acknowledging that the feasibility of STR likely reflects favorable intrinsic patient and pathology characteristics, further high-quality randomized controlled trials are needed to validate these findings.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151520"},"PeriodicalIF":0.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885143","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":"Shoulder arthroplasty in patients with prior hip, knee, or shoulder periprosthetic joint infection: a safe option?","authors":"Daniel E. Goltz MD, MBA,&nbsp;Miguel Fiandeiro BA,&nbsp;Ryan M. Cox MD,&nbsp;Ryan Lopez MD,&nbsp;Nabil Mehta MD,&nbsp;Jie J. Yao MD,&nbsp;Thema Nicholson MS,&nbsp;Mark D. Lazarus MD,&nbsp;Surena Namdari MD, MSc","doi":"10.1016/j.sart.2025.151518","DOIUrl":"10.1016/j.sart.2025.151518","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infection (PJI) following anatomic or reverse total shoulder arthroplasty (aTSA, rTSA) is a fortunately rare but devastating complication. Controversy exists regarding both prevention and treatment. Given its severity to the patient and cost to the system, minimizing its risk remains a priority. Some patients may be seen for consideration of shoulder arthroplasty who have previously been treated for PJI of the other shoulder or lower extremity (ie, hip or knee). However, the effect this clinical history has on the likelihood of subsequent PJI in the primary setting remains unknown. The purpose of this study is to understand whether this history poses increased risk of PJI following aTSA or rTSA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed involving all patients who underwent aTSA or rTSA between May 2011 and September 2023 at a single institution, as well as any patients who experienced a PJI of a total hip or knee arthroplasty between April 1999 and December 2019. Patients with a shoulder, hip, or knee PJI history who subsequently underwent a primary shoulder arthroplasty comprised the study cohort. The clinical course of these patients was then studied for any subsequent PJI.</div></div><div><h3>Results</h3><div>Institutional databases of over 1,000 lower extremity PJI cases and over 100 definite or probable shoulder arthroplasty PJI cases were cross-referenced with over 14,000 available shoulder arthroplasty cases extracted from the electronic medical record. Of these, 16 primary and 2 revision cases in 13 patients were identified that involved an aTSA (N = 4) or rTSA (N = 14) following a prior upper (N = 2) or lower (N = 16) extremity PJI. Median follow-up of all patients was 4.5 years, with 13 patients having a minimum follow-up of 2 years. These cases were performed a median of 3.9 years following treatment of their prior PJI, which most often involved <em>Staphylococcus</em> species (66.6%). No patients experienced a PJI of their shoulder arthroplasty at final follow-up, with mean (standard deviation) American Shoulder Elbow Surgeons scores of 83.0 (9.9). One patient sustained a periprosthetic fracture postoperative day 1 requiring revision, and one patient was revised at 3 weeks for instability.</div></div><div><h3>Discussion</h3><div>A history of prior total hip, knee, or shoulder arthroplasty PJI did not result in the infection of any subsequent primary aTSA or rTSA cases at a single high-volume institution, providing some reassurance as part of the preoperative risk stratification process.</div></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"36 1","pages":"Article 151518"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841502","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}