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Clinical outcomes based on planned glenoid baseplate retroversion in reverse total shoulder arthroplasty 基于反向全肩关节置换术中计划的盂基底板后翻的临床效果
Q4 Medicine Pub Date : 2024-03-13 DOI: 10.1053/j.sart.2024.01.014
Lauren E. Schell BS , Stephanie J. Muh MD , Josie A. Elwell PhD , Skye Jacobson BS , William R. Barfield PhD , Christopher P. Roche MSE, MBA , Josef K. Eichinger MD , Richard J. Friedman MD, FRCSC

Background

While surgeons attempt to correct the baseplate version of a reverse total shoulder arthroplasty (rTSA), clinical outcomes based on the planned final version remain unknown. The purpose of this study is to determine the clinical and radiographic outcomes of rTSA based on the planned final version of the baseplate. Our hypothesis is that increasing component retroversion will not affect outcomes.

Methods

All primary rTSA patients in a multicentered international registry with a 2-year minimum follow-up implanted with computer navigation were included, except fracture and revision indications. A single medialized glenoid/lateralized humerus rTSA implant system was used with a standard or augmented baseplate. Patients were stratified by baseplate type and final planned baseplate version into 2 cohorts: 0°-5° (Group 1) or 6°-15° (Group 2) of retroversion. Demographics, radiographic outcomes, range of motion, and patient-reported outcome scores were compared between groups using Welch’s t-test and Fisher’s Exact test.

Results

Five hundred and thirty-five patients (307 females/226 males/2 unknown) were identified, with a mean follow-up of 30 months. Demographics were similar between the cohorts. The mean native and final retroversion was 9.0° and 1.5° in Group 1 and 16.3° and 8.6° in Group 2, respectively. Preoperatively, 72% of patients were 6°-15° retroverted. Postoperatively, 73% of patients were 0°-5° retroverted and 27% were 6°-15°, with 97% of patients having less than or equal to 10° of planned baseplate retroversion. Without stratifying for baseplate types, there were no clinically significant differences between the cohorts with regards to postoperative pain, range of motion, or patient-reported outcome scores, except for abduction and internal rotation greater in the 6°-15° and 0°-5° cohorts, respectively. Scapular notching was low (7% vs. 8%) and less than reported without computer navigation. Complication and revision rates were similar between the 2 groups. Patient satisfaction was high (much better/better, 94% vs 95%) and not significantly different between the 2 groups.

Discussion

There were no significant clinical differences between cohorts. This study demonstrates that favorable outcomes are achieved with a planned final baseplate version of less than 15° retroversion, with few differences between 0°-5° and 6°-15°. rTSA is forgiving enough such that one may plan to correct preoperative retroversion to less than 15° postoperatively in lieu of targeting postoperative version between 0°-5° for patients with higher native retroversion, potentially requiring less eccentric reaming especially when combined with other corrective measures.

背景当外科医生试图纠正反向全肩关节置换术(rTSA)的基底板版本时,基于计划的最终版本的临床结果仍是未知数。本研究的目的是根据计划的基底板最终版本确定反向全肩关节成形术的临床和影像学结果。除骨折和翻修适应症外,我们纳入了多中心国际注册机构中所有通过计算机导航植入的至少随访2年的初次rTSA患者。采用单一内侧化盂骨/外侧化肱骨rTSA植入系统和标准或增强型基底板。根据基板类型和最终计划的基板版本,将患者分为两组:后倾 0°-5°(第 1 组)或 6°-15°(第 2 组)。采用韦尔奇 t 检验和费舍尔精确检验对两组患者的人口统计学、放射学结果、活动范围和患者报告的结果评分进行比较。两组患者的人口统计学特征相似。第一组患者的原发和最终后凸平均分别为 9.0°和 1.5°,第二组患者的原发和最终后凸分别为 16.3°和 8.6°。术前,72% 的患者后倾 6°-15°。术后,73%的患者后倾0°-5°,27%的患者后倾6°-15°,97%的患者计划的基底板后倾小于或等于10°。在不对基底板类型进行分层的情况下,除了外展和内旋分别在6°-15°和0°-5°组别中更大以外,各组别在术后疼痛、活动范围或患者报告的结果评分方面没有明显的临床差异。肩胛骨切迹率较低(7% 对 8%),低于未使用计算机导航的报告。两组的并发症和翻修率相似。患者满意度很高(更好/更好,94% 对 95%),两组之间无显著差异。这项研究表明,如果计划的最终基底板后倾角度小于15°,就能获得良好的治疗效果,而0°-5°和6°-15°之间的差异很小。rTSA具有足够的容错性,因此可以计划在术后将术前的后倾角度矫正到小于15°,而不是将原位后倾角度较高的患者的术后后倾角度定位在0°-5°之间,这样可能需要较少的偏心扩孔,尤其是在结合其他矫正措施的情况下。
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引用次数: 0
Patients with chronic kidney disease can expect significant improvement in pain and function after shoulder arthroplasty 肩关节置换术后,慢性肾病患者的疼痛和功能有望得到明显改善
Q4 Medicine Pub Date : 2024-03-09 DOI: 10.1053/j.sart.2024.01.011
Katherine A. Burns MD , Lynn M. Robbins PA-C , Angela R. LeMarr BSN, RN, ONC , Varun Gopinatth BS , Diane J. Morton MS, MWC , Melissa L. Wilson PhD, MPH

Background

Chronic kidney disease (CKD) is associated with negative outcomes after hip and knee arthroplasty due to higher rates of infection, aseptic loosening, and transfusion. The purpose of this study was to compare clinical outcome scores and complication rate after shoulder arthroplasty (SA) for patients with and without CKD.

Methods

We conducted a retrospective cohort study of prospectively collected data and reviewed all patients who underwent primary SA from January 2015 to December 2019 by one surgeon at one institution. Revision arthroplasty patients were excluded. We evaluated results from patients with CKD (glomerular filtration rate [GFR] 59) and without CKD (GFR 60). Outcome measures including visual analog scale for pain, American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) scores were compared between cohorts. Minimum clinically important difference (MCID) and substantial clinical benefit also were determined for this cohort. Univariate and multivariable regression was performed to assess the influence of CKD on outcome measures and risk of complications.

Results

518 patients met inclusion criteria; 4 patients did not have recorded GFR, leaving 514 patients for analysis. 389 patients had normal GFR; 125 had CKD. Patients with CKD had lower overall preoperative and postoperative ASES, SST, and SANE scores but demonstrated similar levels of clinical improvement from preoperative to postoperative time points (Δ ASES 41.4 ± 21.8 vs. 42.9 ± 21.4, P = .55), (Δ SST 4.8 ± 3.4 vs. 4.9 ± 3.3, P = .08), (Δ SANE 40.7 ± 29.1 vs. 42.4 ± 26.5, P = .77). Both cohorts achieved MCID for ASES, SST, and SANE scores. Univariately, patients with CKD were at high risk to require transfusion (OR 16.2 (1.9, 139.7), P = .01) despite similar intraoperative estimated blood loss (156.9 ± 132.5mL vs. 153.8 ± 89.7mL, P = .77). CKD patients also were at higher risk for intraoperative fracture (OR 5.4 (1.3, 23.0), P = .02). CKD patients were not at higher risk for prosthetic joint infection (OR 3.2 (0.2, 50.8), P = .42), medical complications (OR 0.9 (0.2, 4.4), P = .89), or revision (OR 1.9 (0.7, 4.9), P = .19) in this cohort. Multivariable analysis of any complication after SA demonstrated that renal disease was not an independent risk factor for overall complication risk in this cohort (OR 1.1 (0.7, 1.8) P = .650).

Conclusion

Surgeons can be assured that patients who have CKD achieve similar gains in clinical outcomes as other patients. Despite experiencing a higher risk for transfusion and intraoperative fracture, renal disease was not an independent risk factor for complications after SA in this small coh

背景慢性肾脏病(CKD)与髋关节和膝关节置换术后的不良预后有关,因为感染、无菌性松动和输血的发生率较高。本研究的目的是比较患有和未患有慢性肾脏病的患者在肩关节置换术(SA)后的临床结果评分和并发症发生率。方法我们对前瞻性收集的数据进行了一项回顾性队列研究,回顾了2015年1月至2019年12月期间由一家机构的一名外科医生进行初次肩关节置换术的所有患者。不包括翻修关节置换术患者。我们评估了患有 CKD(肾小球滤过率 [GFR] ≤ 59)和未患有 CKD(GFR ≥ 60)的患者的结果。结果测量包括疼痛视觉模拟量表、美国肩肘外科医生(ASES)评分、简易肩关节测试(SST)和单次数字评估(SANE)评分。此外,还确定了该队列的最小临床重要性差异(MCID)和实质性临床获益。结果 518 名患者符合纳入标准;4 名患者没有 GFR 记录,因此有 514 名患者可供分析。389名患者的肾小球滤过率正常;125名患者患有慢性肾功能衰竭。患有慢性肾脏病的患者术前和术后的ASES、SST和SANE总评分较低,但从术前到术后各时间点的临床改善程度相似(Δ ASES 41.4 ± 21.8 vs. 42.9 ± 21.4,P = .55),(Δ SST 4.8 ± 3.4 vs. 4.9 ± 3.3,P = .08),(Δ SANE 40.7 ± 29.1 vs. 42.4 ± 26.5,P = .77)。两组患者的 ASES、SST 和 SANE 评分均达到 MCID。单变量来看,尽管术中估计失血量相似(156.9 ± 132.5mL vs. 153.8 ± 89.7mL,P = .77),但 CKD 患者需要输血的风险较高(OR 16.2 (1.9, 139.7),P = .01)。CKD患者术中骨折的风险也更高(OR 5.4 (1.3, 23.0),P = .02)。在该队列中,CKD 患者发生假体关节感染(OR 3.2 (0.2, 50.8),P = .42)、医疗并发症(OR 0.9 (0.2, 4.4),P = .89)或翻修(OR 1.9 (0.7, 4.9),P = .19)的风险并不高。对 SA 术后任何并发症的多变量分析表明,肾脏疾病不是该组患者总体并发症风险的独立危险因素(OR 1.1 (0.7, 1.8) P = .650)。尽管肾病患者输血和术中骨折的风险较高,但在这一小型群体中,肾病并不是SA术后并发症的独立风险因素。
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引用次数: 0
Complications associated with postoperative stiffness following primary anatomic and reverse total shoulder arthroplasty 与原位解剖和反向全肩关节置换术后僵硬有关的并发症
Q4 Medicine Pub Date : 2024-03-04 DOI: 10.1053/j.sart.2024.01.012
Lawrence C. Vanderham MS, PA, Nikhil Vallabhaneni BA, Skye Jacobson BS, Jacqueline G. Tobin MS, Alexander S. Guareschi BS, Josef K. Eichinger MD, Richard J. Friedman MD, FRCSC

Background

Shoulder stiffness following both primary anatomic and reverse total shoulder arthroplasty (TSA) is a potential complication that is likely underreported. The deleterious effects of postoperative stiffness following TSA and the burden placed on both the patient and the healthcare system have not been well studied. The purpose of this study is to determine the incidence of postoperative stiffness following primary TSA and analyze the effect it has on short-term outcomes up to 180 days following primary TSA.

Methods

This was a retrospective, comparative cohort study. The Nationwide Readmissions Database was queried from 2010 to 2020 for patients who had undergone primary TSA using International Classification of Diseases Clinical Modification and Procedure Coding System codes. Patients were then separated into stiff and non-stiff cohorts. A one-to-one match was performed based on age, sex, and the Charlson comorbidity index. Statistical analyses included chi-square, sample t-tests, logistic, and linear regression.

Results

A total of 7792 subjects were included in the study. The overall incidence of postoperative stiffness was 1.8%. Patients with stiffness following primary TSA were 57% more likely to be readmitted within 180 days (odds ratio [OR] = 1.57) and had increased hospital costs by over $5000 (P < .001), but mortality rates were not increased. However, the odds of experiencing any medical complication or revision decreased by 52% and 76%, respectively, in the stiff group (OR = 0.48, and OR = 0.24, respectively). Postoperative stiffness was inversely predictive of prosthetic dislocation (OR = 0.03), loosening (OR = 0.03), and periprosthetic fracture (OR = 0.04).

Conclusion

The incidence of postoperative stiffness following primary TSA was low at 1.8 %. These patients were found to be at increased risk for readmission within 180 days and incurred significantly higher hospital costs compared to the non-stiff cohort. However, postoperative stiffness did not increase the odds of experiencing increased medical complications, mechanical complications, mortality, or revision at 180 days. This information can help guide surgeons in discussion with and management of patients who develop stiffness following primary TSA.

背景原位解剖和反向全肩关节置换术(TSA)后肩关节僵硬是一种潜在的并发症,但很可能未得到充分报道。关于 TSA 术后肩关节僵硬的有害影响以及给患者和医疗系统造成的负担,目前还没有很好的研究。本研究的目的是确定原发性 TSA 术后僵硬的发生率,并分析其对原发性 TSA 术后 180 天内短期预后的影响。利用国际疾病分类临床修改和程序编码系统代码查询了2010年至2020年期间全国再入院数据库中接受过原发性TSA手术的患者。然后将患者分为僵硬组群和非僵硬组群。根据年龄、性别和 Charlson 合并症指数进行一对一匹配。统计分析包括卡方检验、样本 t 检验、逻辑回归和线性回归。术后僵硬的总发生率为 1.8%。初次 TSA 术后出现僵硬的患者在 180 天内再次入院的几率比常人高出 57%(几率比 [OR] = 1.57),住院费用也增加了 5000 多美元(P <.001),但死亡率并没有增加。不过,在僵硬组中,出现任何医疗并发症或翻修的几率分别降低了 52% 和 76%(OR = 0.48 和 OR = 0.24)。术后僵硬与假体脱位(OR = 0.03)、松动(OR = 0.03)和假体周围骨折(OR = 0.04)呈反向预测关系。与非僵硬患者相比,这些患者在 180 天内再次入院的风险增加,住院费用也明显增加。不过,术后僵硬并不会增加患者在180天内出现更多医疗并发症、机械并发症、死亡率或翻修的几率。这些信息有助于指导外科医生与初诊 TSA 术后出现僵硬的患者进行讨论并对其进行管理。
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引用次数: 0
Regional compared to general anesthesia for total shoulder arthroplasty 全肩关节置换术中区域麻醉与全身麻醉的比较
Q4 Medicine Pub Date : 2024-03-04 DOI: 10.1053/j.sart.2024.01.013
Nikhil Vallabhaneni BA, Lawrence C. Vanderham MS, PA-C, Skye Jacobson BS, Jacqueline G. Tobin MS, Alexander S. Guareschi BS, Josef K. Eichinger MD, Richard J. Friedman MD, FRCSC

Background

Total shoulder arthroplasty (TSA) is a common procedure for numerous shoulder pathologies, including glenohumeral arthritis, rotator cuff tears, and proximal humerus fractures. Prior literature has shown that patients undergoing total hip and knee arthroplasty under regional anesthesia (RA) are at significantly lower risk of postoperative complications and reoperation compared to general anesthesia (GA). The purpose of this study is to compare GA vs. RA in patients undergoing primary elective TSA.

Methods

The National Surgical Quality Improvement Program database was queried from 2010 to 2019 to identify all patients who underwent primary elective TSA with the use of GA (n = 24,563) or RA (n = 475). After matching based on age, sex, and the American Society of Anesthesiologists classification score, 475 matched pairs of patients undergoing TSA using GA or RA were compared. Relevant demographic characteristics and postoperative complication, readmission, and reoperation rates within 30 days of surgery were compared between groups. Operative time and total hospital length of stay (LOS) were also compared. Chi-squared tests were used to compare categorical variables. Continuous variables were compared using independent sample t-test and one-way ANOVA for binomial and multinomial groups, respectively.

Results

RA patients exhibited significantly higher rates of readmission (P < .001) and reoperation (P = .034) compared to GA patients. GA patients showed higher operative times than RA patients when comparing the two cohorts and stratifying patients by body mass index. GA patients also exhibited significantly increased LOS (P=<.001) compared to RA patients. Except for increased readmission and reoperation rates, there was no significant difference in the remaining medical complication rates between the groups.

Conclusion

RA patients were found to have higher rates of readmission and reoperation within 30 days of surgery compared to GA patients. GA was associated with longer operative times compared to RA across various body mass index groups. GA was associated with longer LOS compared to RA. However, for all perioperative and short-term postoperative medical complications, patients undergoing TSA under RA had similar rates to GA patients. These findings can be used to guide clinical decision-making when selecting the appropriate anesthetic strategy for patients requiring elective primary TSA.

背景全肩关节置换术(TSA)是治疗多种肩部病症的常见手术,包括盂肱关节炎、肩袖撕裂和肱骨近端骨折。先前的文献显示,与全身麻醉(GA)相比,在区域麻醉(RA)下接受全髋关节和膝关节置换术的患者术后并发症和再次手术的风险要低得多。本研究的目的是对接受初级择期TSA手术的患者进行GA与RA的比较。方法查询了2010年至2019年的国家外科质量改进计划数据库,以确定所有接受初级择期TSA手术并使用GA(n = 24,563)或RA(n = 475)的患者。根据年龄、性别和美国麻醉医师协会分类评分进行匹配后,对 475 对使用 GA 或 RA 进行 TSA 的匹配患者进行了比较。比较了两组患者的相关人口统计学特征、术后并发症发生率、再入院率以及术后 30 天内的再次手术率。同时还比较了手术时间和总住院时间(LOS)。采用卡方检验比较分类变量。连续变量分别采用独立样本 t 检验和单因素方差分析对二项组和多项组进行比较。结果与 GA 患者相比,RA 患者的再入院率(P < .001)和再手术率(P = .034)明显更高。将两组患者进行比较并按体重指数进行分层后,GA 患者的手术时间高于 RA 患者。与 RA 患者相比,GA 患者的 LOS 也明显增加(P=0.001)。除了再入院率和再手术率增加外,两组患者在其余医疗并发症发生率方面没有明显差异。在不同体重指数组别中,GA 的手术时间比 RA 长。与 RA 相比,GA 与更长的 LOS 相关。然而,就所有围手术期和术后短期医疗并发症而言,在RA条件下接受TSA手术的患者与GA患者的并发症发生率相似。这些研究结果可用于指导临床决策,为需要进行选择性初级 TSA 的患者选择合适的麻醉策略。
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引用次数: 0
Glenoid fixation strategies: cemented, metal-backed, and hybrid 瓣膜固定策略:骨水泥固定、金属支撑固定和混合固定
Q4 Medicine Pub Date : 2024-03-01 DOI: 10.1053/j.sart.2023.07.001
Nikhil Adapa MD, Andrew J. Rosso BS, Salvatore M. Cavallaro MD, Kevin J. Setter MD

Background

Glenoid loosening and wear remain one of the most common complications after total shoulder arthroplasty. In this article, we will review all polyethylene glenoids, metalbacked glenoids, inlay glenoids, and hybrid constructs.

Methods

We hope to synthesize existing literature to understand strategies that can contribute to a more durable and longer lasting implant.

Results

Although all polyethylene glenoids remain the gold standard, recent literature hints at the potential benefits of metal-backed, inset and hybrid glenoids.

Conclusion

As the number of total shoulder arthroplasties that are being done annually continues to rise, renewed interest into glenoid fixation strategies is paramount to help improve patient satisfaction, implant durability, and combat rising healthcare expenditure.

背景瓣膜松动和磨损仍是全肩关节置换术后最常见的并发症之一。本文将综述所有聚乙烯盂形结构、金属支撑盂形结构、嵌体盂形结构和混合结构。方法我们希望综合现有文献,了解有助于植入物更耐用、更持久的策略。结果尽管所有聚乙烯盂形结构仍是黄金标准,但最近的文献提示了金属支撑、嵌体和混合盂形结构的潜在益处。结论随着每年进行的全肩关节置换术数量不断增加,重新关注盂成形固定策略对于帮助提高患者满意度、植入物耐用性和应对不断增加的医疗支出至关重要。
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引用次数: 0
Early radiographic and clinical outcomes of primary short stem anatomic total shoulder arthroplasty with a peripherally enhanced fixation glenoid: a multicenter study 采用外周增强固定盂成形术的原发性短柄解剖型全肩关节成形术的早期影像学和临床疗效:一项多中心研究
Q4 Medicine Pub Date : 2024-02-17 DOI: 10.1053/j.sart.2024.01.007
Vahid Entezari MD, MMSc , Jason C. Ho MD , Sambit Sahoo MD, PhD , Michael Del Core MD , Dylan Cannon BS , Gagan Grewal BS , Tammy M. Owings DEng , Jinjin Ma PhD , Catherine Shemo BS , Andrew Baker MS , Bong Jae Jun PhD , Yuxuan Jin MS , Peter B. Imrey PhD , Joseph P. Iannotti MD, PhD , Eric T. Ricchetti MD , Kathleen Derwin PhD , Jonathan Levy MD

Background

Glenoid component loosening remains the most common reason for revision of anatomic total shoulder arthroplasty (aTSA). We assessed early clinical and radiographic outcomes following aTSA using a press-fit short stem and a peripherally enhanced fixation glenoid.

Methods

275 consecutive patients with end-stage glenohumeral arthritis and Walch A- or B-type glenoid morphology who underwent primary aTSA in 2017-2018 at two high-volume shoulder arthroplasty institutions were evaluated, and patient-reported outcomes (PROMs) and radiographic findings were studied in those with completed baseline and minimum 2-year follow-up, respectively. Patient demographics, glenoid morphology, body mass index (BMI), Charlson Comorbidity Index (CCI), range of motion, American Shoulder and Elbow Surgeons (ASES) score, and Simple Assessment Numeric Evaluation score were collected. Radiographic analysis of glenoid and humeral components was performed. Multivariable logistic, equal adjacent odds ordinal, and beta regression were respectively used to identify predictors of glenoid radiolucent lines, humeral calcar resorption, and total ASES score.

Results

Patients were 43% female, with a mean age of 66, a median BMI of 30, and median follow-up of 28.4 months. ASES and Simple Assessment Numeric Evaluation scores improved by respective medians of 54.4 and 55.0 points, forward elevation by median 35°, and external rotation by median 30° (all P < .001 for preoperative to postoperative change). Postoperative radiographs of 177 cases showed 10 (5.7%) glenoid osteolysis, 51 (28.8%) glenoid radiolucent lines, and 81 (45.8%) calcar resorptions. The follow-up duration (median 40.1 vs. 27.2 months; P < .001), BMI (median 27.5 vs. 30.7; P < .001), and Charlson Comorbidity Index (Q3 0 vs. 1; P = .02) were associated with glenoid osteolysis in bivariate analyses. In multiple logistic regression, surgeon (C vs. A/B) was the only statistically significant predictor of glenoid radiolucent lines [OR 0.27, 95% CI (0.1, 0.8)]. By descending importance, Surgeon C [OR 6.5 (2.0, 20.5)], humeral canal filling ratio [upper vs. lower quartile OR 2.3 (1.3, 4.0)], mediolateral humeral head deviation [upper vs. lower quartile OR 1.9 (1.0, 3.5)], and glenoid osteolysis [OR 13.5 (2.6, 71.6)] significantly predicted greater calcar resorption. Longer follow-up duration marginally statistically significantly predicted lower ASES score [upper vs. lower quartile OR 0.8 (0.6, 1.0)].

Conclusions

Following aTSA with a peripherally enhanced fixation glenoid, pain, range of motion, and patient-reported outcomes significantly improved at a minimum of 2 years with only 5.7% glenoid osteolysis despite heterogeneous preoperative glenoid pathologies.

背景盂组件松动仍是解剖型全肩关节置换术(aTSA)翻修的最常见原因。我们评估了使用压入式短柄和外周增强固定盂体的aTSA术后早期临床和放射学结果。方法对2017-2018年在两家高产量肩关节置换机构接受初次aTSA术的275例连续患者进行了评估,并分别对完成基线和至少2年随访的患者的患者报告结果(PROMs)和放射学结果进行了研究。研究人员收集了患者的人口统计学资料、盂状关节形态、体重指数(BMI)、夏尔森合并症指数(CCI)、活动范围、美国肩肘外科医生(ASES)评分和简单评估数字评价评分。对盂和肱骨部件进行了X光分析。分别采用多变量逻辑回归、相邻几率相等序数回归和贝塔回归来确定盂骨放射线、肱骨钙吸收和ASES总分的预测因素。 结果患者中43%为女性,平均年龄66岁,中位体重指数(BMI)30,中位随访时间28.4个月。ASES和简单数字评估得分的中位数分别提高了54.4分和55.0分,前抬度的中位数提高了35°,外旋度的中位数提高了30°(术前与术后变化的P均为0.001)。177 例患者的术后 X 光片显示,10 例(5.7%)盂骨溶解,51 例(28.8%)盂骨放射线,81 例(45.8%)钙痕吸收。在双变量分析中,随访时间(中位数为 40.1 个月 vs. 27.2 个月;P < .001)、体重指数(中位数为 27.5 vs. 30.7;P < .001)和 Charlson 合并指数(Q3 0 vs. 1;P = .02)与盂骨溶解有关。在多元逻辑回归中,外科医生(C vs. A/B)是盂骨放射线唯一具有统计学意义的预测因素[OR 0.27, 95% CI (0.1, 0.8)]。按照重要性降序排列,外科医生C[OR 6.5 (2.0, 20.5)]、肱骨管充盈率[上四分位与下四分位OR 2.3 (1.3, 4.0)]、肱骨头内侧偏离[上四分位与下四分位OR 1.9 (1.0, 3.5)]和盂骨溶解[OR 13.5 (2.6, 71.6)]显著预测了更大的钙痕吸收。随访时间越长,ASES评分越低[上四分位与下四分位OR 0.8 (0.6, 1.0)],这在统计学上有轻微的显著预测作用。结论使用外周增强固定盂体的TSA术后,疼痛、活动范围和患者报告的结果在至少2年后有显著改善,盂骨溶解率仅为5.7%,尽管术前存在多种病理情况。
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引用次数: 0
Acute bony Bankart and proximal humeral dislocation in an elderly patient treated with distal tibial allograft glenoid augmentation and reverse shoulder arthroplasty: a case report 用胫骨远端同种异体盂成形术和反向肩关节置换术治疗一名老年患者的急性肱骨髁和肱骨近端脱位:病例报告
Q4 Medicine Pub Date : 2024-02-17 DOI: 10.1053/j.sart.2024.01.005
Edwin A. Valencia-Ramon MD, Rocio Pasache-Lozano MD, J. Andrew I. Trenholm MD, MSc, FRCS, Ivan Wong MD, FRCSC, MAcM, Dip Sports Med, FAANA
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引用次数: 0
Does prior ipsilateral steroid injection affect outcomes after shoulder arthroplasty? 先前的同侧类固醇注射会影响肩关节置换术后的效果吗?
Q4 Medicine Pub Date : 2024-02-17 DOI: 10.1053/j.sart.2024.01.008
Sarah J. Girshfeld BA , Gabriel Lama BS , Brandon Macknofsky BS , Clyde Fomunung BS, MBA , Devin John MD , Garrett R. Jackson MD , Howard Routman MD , Vani J. Sabesan MD

Background

Steroid injections are a well-known first-line treatment for glenohumeral osteoarthritis; however, many patients eventually require definitive management with surgery. Recent literature has called into question the safety of steroid injections before shoulder surgery due to increased infections and revisions. Conclusive data regarding the relationship between preoperative injection and postoperative outcomes is lacking. This study aimed to determine the impact of ipsilateral injections on clinical outcomes following shoulder arthroplasty (SA).

Methods

A retrospective study was performed on patients who underwent SA by a single fellowship-trained orthopedic surgeon from 2017 to 2021. Patients were divided into two cohorts based on preoperative corticosteroid injection: (1) injection group (IG) and (2) no injection (control group (CG)). The IG was further stratified based on number of injections (1 vs. ≥2 injections) and timing of injections relative to surgery (<3 months, 3-12 months, and >12 months). Patient-reported pain and satisfaction, simple shoulder test, shoulder pain and disability index, visual analog scale for pain, University of California-Los Angeles score, American Shoulder and Elbow Surgeons score, Constant-Murley score, range of motion, complications, and reoperations were collected preoperatively and at final follow-up. Comparisons were made between groups and the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were calculated for each score.

Results

421 patients (IG = 98 patients, CG = 323 patients) were included, with mean follow-up of 22 months. The IG had more females (69.1% vs. 48.9%; P < .001) and older age (75 vs. 70; P < .001). There was significantly greater preoperative range of motion in the IG for forward elevation (80° vs. 70°; P = .025) and abduction (70° vs. 60°; P = .004). At final follow-up, all groups had a high percentage (mean 80.26%) of patients exceeding both MCID and SCB for all measures. More patients in the IG exceeded MCID and SCB for visual analog scale for pain (P = .009 and P = .007, respectively), and MCID for American Shoulder and Elbow Surgeons (P = .046) compared to the CG. The group with ≥2 injections reported worse shoulder pain and disability index scores (P = .024). Complication and reoperation rates were comparable between groups.

Conclusion

Our study indicates that a single ipsilateral shoulder injection did not worsen postoperative outcomes or complication rates following SA. However, patients who received two or more injections had inferior patient-reported outcomes. Surgeons can continue to use injections as a viable first-line management option before shoulder arthroplasty for reliable pain relief without concerns for increased complications.

背景类固醇注射是众所周知的治疗盂肱骨关节炎的一线疗法;然而,许多患者最终需要通过手术进行明确治疗。最近的文献对肩关节手术前注射类固醇的安全性提出了质疑,原因是感染和翻修增加。关于术前注射与术后效果之间的关系,目前还缺乏确凿的数据。本研究旨在确定同侧注射对肩关节置换术(SA)后临床疗效的影响。方法对2017年至2021年期间由一名接受过研究培训的骨科医生进行肩关节置换术的患者进行回顾性研究。根据术前皮质类固醇注射情况将患者分为两组:(1)注射组(IG)和(2)无注射组(对照组(CG))。注射组根据注射次数(1 次与≥2 次)和相对于手术的注射时间(3 个月、3-12 个月和 12 个月)进一步分层。在术前和最终随访时收集患者报告的疼痛和满意度、简单肩关节测试、肩关节疼痛和残疾指数、疼痛视觉模拟量表、加州大学洛杉矶分校评分、美国肩肘外科医生评分、Constant-Murley评分、活动范围、并发症和再手术情况。结果421例患者(IG=98例,CG=323例)被纳入研究,平均随访时间为22个月。IG患者中女性较多(69.1%对48.9%;P < .001),年龄较大(75岁对70岁;P < .001)。术前,IG 组的前倾(80° 对 70°;P = .025)和外展(70° 对 60°;P = .004)活动范围明显更大。在最后的随访中,所有组别均有很高比例的患者(平均 80.26%)在所有测量指标上都超过了 MCID 和 SCB。与CG相比,IG组中有更多患者的疼痛视觉模拟量表超过了MCID和SCB(分别为P = .009和P = .007),美国肩肘外科医生的MCID超过了MCID(P = .046)。注射次数≥2 次的组的肩痛和残疾指数评分更差(P = .024)。结论:我们的研究表明,单次同侧肩部注射不会恶化 SA 术后结果或并发症发生率。我们的研究表明,单次同侧肩关节注射不会恶化 SA 术后效果或并发症发生率,但接受两次或更多次注射的患者的患者报告结果较差。外科医生可以继续将注射作为肩关节置换术前可行的一线治疗方案,以可靠地缓解疼痛,而不必担心并发症的增加。
{"title":"Does prior ipsilateral steroid injection affect outcomes after shoulder arthroplasty?","authors":"Sarah J. Girshfeld BA ,&nbsp;Gabriel Lama BS ,&nbsp;Brandon Macknofsky BS ,&nbsp;Clyde Fomunung BS, MBA ,&nbsp;Devin John MD ,&nbsp;Garrett R. Jackson MD ,&nbsp;Howard Routman MD ,&nbsp;Vani J. Sabesan MD","doi":"10.1053/j.sart.2024.01.008","DOIUrl":"https://doi.org/10.1053/j.sart.2024.01.008","url":null,"abstract":"<div><h3>Background</h3><p>Steroid injections are a well-known first-line treatment for glenohumeral osteoarthritis; however, many patients eventually require definitive management with surgery. Recent literature has called into question the safety of steroid injections before shoulder surgery due to increased infections and revisions. Conclusive data regarding the relationship between preoperative injection and postoperative outcomes is lacking. This study aimed to determine the impact of ipsilateral injections on clinical outcomes following shoulder arthroplasty (SA).</p></div><div><h3>Methods</h3><p>A retrospective study was performed on patients who underwent SA by a single fellowship-trained orthopedic surgeon from 2017 to 2021. Patients were divided into two cohorts based on preoperative corticosteroid injection: (1) injection group (IG) and (2) no injection (control group (CG)). The IG was further stratified based on number of injections (1 vs. ≥2 injections) and timing of injections relative to surgery (&lt;3 months, 3-12 months, and &gt;12 months). Patient-reported pain and satisfaction, simple shoulder test, shoulder pain and disability index, visual analog scale for pain, University of California-Los Angeles score, American Shoulder and Elbow Surgeons score, Constant-Murley score, range of motion, complications, and reoperations were collected preoperatively and at final follow-up. Comparisons were made between groups and the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were calculated for each score.</p></div><div><h3>Results</h3><p>421 patients (IG = 98 patients, CG = 323 patients) were included, with mean follow-up of 22 months. The IG had more females (69.1% vs. 48.9%; <em>P</em> &lt; .001) and older age (75 vs. 70; <em>P</em> &lt; .001). There was significantly greater preoperative range of motion in the IG for forward elevation (80° vs. 70°; <em>P</em> = .025) and abduction (70° vs. 60°; <em>P</em> = .004). At final follow-up, all groups had a high percentage (mean 80.26%) of patients exceeding both MCID and SCB for all measures. More patients in the IG exceeded MCID and SCB for visual analog scale for pain (<em>P</em> = .009 and <em>P</em> = .007, respectively), and MCID for American Shoulder and Elbow Surgeons (<em>P</em> = .046) compared to the CG. The group with ≥2 injections reported worse shoulder pain and disability index scores (<em>P</em> = .024). Complication and reoperation rates were comparable between groups.</p></div><div><h3>Conclusion</h3><p>Our study indicates that a single ipsilateral shoulder injection did not worsen postoperative outcomes or complication rates following SA. However, patients who received two or more injections had inferior patient-reported outcomes. Surgeons can continue to use injections as a viable first-line management option before shoulder arthroplasty for reliable pain relief without concerns for increased complications.</p></div>","PeriodicalId":39885,"journal":{"name":"Seminars in Arthroplasty","volume":"34 2","pages":"Pages 398-405"},"PeriodicalIF":0.0,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072694","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
Outcomes of anatomic total shoulder arthroplasty revised to reverse shoulder arthroplasty in patients with contained central glenoid bone defects 对中央盂骨缺损患者进行解剖型全肩关节置换术改良为反向肩关节置换术的结果
Q4 Medicine Pub Date : 2024-02-16 DOI: 10.1053/j.sart.2024.01.010
Guillermo Marquez MD , Seth L. Carder MD , Brennen L. Lucas MD , Harry A. Morris MD , Bernard F. Hearon MD

Background

The purpose of this study is to present the outcomes of patients with failed total shoulder arthroplasty (TSA) who were treated by conversion to reverse shoulder arthroplasty (RSA).

Methods

This retrospective cohort study investigates patients who underwent single-stage revision from TSA to RSA by one of three fellowship-trained orthopedic surgeons between 2012 and 2020. Patients with central bone defects in the glenoid were included, whereas those with uncontained peripheral or combined glenoid defects or with infections requiring a 2-stage revision were excluded. The glenoid baseplate size and use of bone graft augmentation were recorded. A minimum 2-year postsurgical follow-up was required to participate in the outcome evaluations. Primary outcome measures were shoulder pain on the visual analog scale and active shoulder forward flexion and abduction, while secondary outcome measures included patient satisfaction, procedure complications, and reoperations. The Wilcoxon signed rank exact test was used to compare preoperative and postoperative clinical data.

Results

Data from 18 shoulders in 16 patients, average age 74 years, were analyzed. The standard 28-mm-sized baseplate with longer and wider central peg was implanted in 12 of 18 reconstructions. Bone graft augmentation of the glenoid was required in 4 of 6 cases when the 25-mm mini baseplate was used. Clinical evaluation of 13 patients (15 shoulders) with an average of 5 (range, 2-10) years after surgery showed statistically significant improvements in median visual analog scale shoulder pain score decreasing from 7 to 0 (P < .001), median active shoulder forward flexion increasing from 90° to 140° (P < .001), and median active shoulder abduction increasing from 60° to 125° (P < .001). In 14 of 15 cases, the patient was satisfied with the outcome. There were minor complications in 2 cases (13%), but there were no major complications or reoperations.

Conclusion

In patients with symptomatic TSA from component failure, shoulder instability, or rotator cuff insufficiency, single-stage revision to RSA for those with contained glenoid bone defects is a reliable salvage option to reduce shoulder pain and improve shoulder motion. At a mean 5-year follow-up, we observed 100% implant survival in 15 cases.

背景本研究旨在介绍全肩关节置换术(TSA)失败患者转为反向肩关节置换术(RSA)治疗的结果。方法这项回顾性队列研究调查了2012年至2020年间由三位接受过研究员培训的骨科医生中的一位接受TSA到RSA单阶段翻修的患者。研究纳入了髋臼中心骨缺损的患者,但排除了周边骨缺损或合并髋臼缺损的患者,也排除了因感染而需要进行两阶段翻修的患者。髋臼基底板的尺寸和植骨增量的使用情况都被记录在案。参加结果评估需要至少两年的术后随访。主要结果指标为视觉模拟量表上的肩部疼痛和肩部主动前屈和外展,次要结果指标包括患者满意度、手术并发症和再次手术。采用 Wilcoxon 符号秩精确检验比较术前和术后的临床数据。在 18 例重建中,有 12 例植入了标准的 28 毫米大小的基板,基板中央的钉子更长更宽。在使用 25 毫米微型基板的 6 个病例中,有 4 个需要进行盂骨移植增量。对术后平均 5 年(2-10 年)的 13 例患者(15 个肩关节)进行的临床评估显示,中位视觉模拟量表肩关节疼痛评分从 7 分降至 0 分(P < .001),中位主动肩关节前屈从 90°增至 140°(P < .001),中位主动肩关节外展从 60°增至 125°(P < .001),这些改善均具有统计学意义。15例病例中有14例患者对治疗结果表示满意。结论对于因组件失效、肩关节不稳定或肩袖功能不全而导致无症状TSA的患者,将包含盂骨缺损的患者单期翻修为RSA是一种可靠的挽救方法,可减轻肩痛并改善肩关节活动。在平均 5 年的随访中,我们观察到 15 个病例的植入物存活率达到 100%。
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引用次数: 0
YouTube content on shoulder arthroplasty is highly viewed but is of poor educational quality YouTube 上有关肩关节置换术的内容浏览量很高,但教育质量不佳
Q4 Medicine Pub Date : 2024-02-16 DOI: 10.1053/j.sart.2024.01.009
Javier Ardebol MD, MBA , Ali Īhsan Kiliç MD , Simon Hwang MS , Theresa Pak DO , Mariano E. Menendez MD , Patrick J. Denard MD

Background

YouTube videos on shoulder arthroplasty cover a broad range of topics, from patient testimonials to surgical techniques. Inherent to this platform, there are no quality control measures to monitor this content. The purpose of this study is to evaluate the quality and popularity of videos on shoulder arthroplasty on YouTube, using both previously described scores and a proposed novel shoulder arthroplasty–specific score assessing educational content.

Methods

A search was performed using the keywords “shoulder arthroplasty” and “shoulder replacement” on YouTube. Videos were sorted by relevance and the first 50 videos for each keyword were included in a playlist. The videos in the playlist were then sorted by popularity and the first 50 were included for analysis. Videos in a non-English language, duplicate videos, or those lacking audio were excluded. Video source, content, time since upload, duration, like and dislike count, were inputted for analysis. The view ratio and video power index were used to assess for popularity. Quality, reliability and educational content were evaluated with the Global Quality Score (GQS), Journal of the American Medical Association (JAMA), and the novel Shoulder Arthroplasty Video Content (SAVC) score, respectively.

Results

The 50 videos had an average of 285,375 views and a mean duration of 10.8 minutes. Video content was comprised of primarily surgical technique (46%) and patient experience (44%), with most of the videos uploaded from university-affiliated physicians (30%), non-affiliated physicians (28%), and medical (i.e., animations from health websites) (26%) sources. Mean GQS (i.e., quality) and JAMA (i.e., reliability) scores for all videos were 3.2 ± 1.2 out of 5 and 2.4 ± 1.4 out of 4, respectively. Median GQS was comparable across sources, content, and procedure type. Although median JAMA scores were similar among procedure and content type, academic and medical sources showed significantly higher scores among video source categories (P = .04). The mean SAVC score was 19.5 ± 10.7 out of 45 possible points. While there was no significant difference in SAVC scores when categorized by procedure type, a significant difference was observed when assessed by source (P = .02) and content (P = .01). Specifically, medical sources had the highest median score for video source and patient experience for content.

Conclusion

Shoulder arthroplasty videos on YouTube reach a considerable audience, but the educational content and reliability are low. Understanding this can help caution patients on the limitations of educational content on YouTube.

背景YouTube 上有关肩关节置换术的视频涵盖了从患者感言到手术技巧等广泛的主题。该平台本身没有质量控制措施来监控这些内容。本研究的目的是评估 YouTube 上肩关节置换术视频的质量和受欢迎程度,同时使用以前描述过的评分方法和新提出的肩关节置换术专用评分方法来评估教育内容。根据相关性对视频进行排序,每个关键词的前 50 个视频被纳入播放列表。然后按受欢迎程度对播放列表中的视频进行排序,并将前 50 个视频纳入分析。非英语语言的视频、重复视频或缺少音频的视频将被排除在外。分析时输入了视频来源、内容、上传时间、持续时间、喜欢和不喜欢次数。观看率和视频功率指数用于评估受欢迎程度。质量、可靠性和教育内容分别采用全球质量评分(GQS)、《美国医学会杂志》(JAMA)和新颖的肩关节成形术视频内容(SAVC)评分进行评估。视频内容主要由手术技巧(46%)和患者体验(44%)组成,大部分视频来自大学附属医院的医生(30%)、非附属医院的医生(28%)和医疗机构(即健康网站上的动画)(26%)。所有视频的 GQS(即质量)和 JAMA(即可靠性)平均值分别为 3.2 ± 1.2(满分 5 分)和 2.4 ± 1.4(满分 4 分)。不同来源、内容和手术类型的 GQS 中位数相当。虽然不同手术和内容类型的 JAMA 中位数得分相似,但学术和医疗来源的视频来源类别得分明显更高(P = .04)。SAVC 平均分为 19.5 ± 10.7(满分 45 分)。虽然按手术类型分类时,SAVC 分数没有明显差异,但按来源(P = .02)和内容(P = .01)评估时,则出现了明显差异。结论YouTube 上的肩关节置换术视频拥有大量受众,但教育内容和可靠性较低。了解这一点有助于提醒患者注意 YouTube 上教育内容的局限性。
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引用次数: 0
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Seminars in Arthroplasty
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