Journal of Shoulder and Elbow Surgery最新文献

{"title":"Modular baseplate augmentation: a simple and effective method for addressing eccentric glenoid wear","authors":"Jason Corban MD ,&nbsp;Adam R. Bowler BA ,&nbsp;Evan A. Glass BS ,&nbsp;James R. Brownhill PhD ,&nbsp;Cole Myers BS ,&nbsp;Brian Hodorek BS, MBA ,&nbsp;Matthew Purdy BS, MBA ,&nbsp;Daniel Vasconcellos BS, MS ,&nbsp;Kiet Le PA-C ,&nbsp;Luke S. Austin MD ,&nbsp;Derek J. Cuff MD ,&nbsp;Anand M. Murthi MD ,&nbsp;Matthew J. Smith MD ,&nbsp;J. Michael Wiater MD ,&nbsp;Andrew Jawa MD","doi":"10.1016/j.jse.2024.06.005","DOIUrl":"10.1016/j.jse.2024.06.005","url":null,"abstract":"<div><h3>Background</h3><div>Augmented baseplates can be effective at addressing eccentric glenoid wear in reverse total shoulder arthroplasty. However, these implants often come in a limited number of predetermined shapes that require additional reaming to ensure adequate glenoid seating. This typically involves complex instrumentation and can have a negative impact on implant stability. Modular baseplate augmentation based on intraoperative measurements may allow for more precise defect filling while preserving glenoid bone. The purpose of this investigation was to assess the stability of a novel ringed baseplate with modular augmentation in comparison with nonaugmented standard and ringed baseplate designs.</div></div><div><h3>Methods</h3><div>In this biomechanical study, baseplate micromotion was tested for 3 constructs according to the American Society for Testing and Materials guidelines. The constructs included a nonaugmented curved baseplate, a nonaugmented ringed baseplate, and a ringed baseplate with an 8-mm locking modular augmentation peg. The nonaugmented constructs were mounted flush onto polyurethane foam blocks, whereas the augmented baseplate was mounted on a polyurethane block with a simulated defect. Baseplate displacement was measured before and after 100,000 cycles of cyclic loading.</div></div><div><h3>Results</h3><div>Before cyclic loading, the nonaugmented and augmented ringed baseplates both demonstrated significantly less micromotion than the nonaugmented curved baseplate design (81.1 μm vs. 97.2 μm vs. 152.7 μm; <em>P</em> = .009). After cyclic loading, both ringed constructs continued to have significantly less micromotion than the curved design (105.5 μm vs. 103.2 μm vs. 136.6 μm; <em>P</em> &lt; .001). The micromotion for both ringed constructs remained below the minimum threshold required for bony ingrowth (150 μm) at all time points.</div></div><div><h3>Conclusions</h3><div>In the setting of a simulated glenoid defect, locked modular augmentation of a ringed baseplate does not result in increased baseplate micromotion when compared with full contact nonaugmented baseplates. This design offers a simple method for tailored baseplate augmentation that can match specific variations in glenoid anatomy, limiting the need for excessive reaming and ultimately optimizing the environment for long-term implant stability.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 606-616"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Editorial Commentary on the Article \"Latarjet Procedure: Open with Screws or Arthroscopic with Cortical-Buttons\".","authors":"Alexandre T Nascimento, Caio S Checchia, Jorge H Assunção, Mauro E C Gracitelli, Fernando B Andrade-Silva, Robson M Bastos, Arnaldo F F Neto, Eduardo A Malavolta","doi":"10.1016/j.jse.2024.12.026","DOIUrl":"https://doi.org/10.1016/j.jse.2024.12.026","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications and revisions in metal-backed anatomic total shoulder arthroplasty: a comparative study of revision rates between stemless and stemmed humeral components","authors":"Moritz Kraus ,&nbsp;Johanna Illner ,&nbsp;Mara Warnhoff MD ,&nbsp;Moritz Brunner ,&nbsp;Tim Schneller ,&nbsp;Asimina Lazaridou PhD ,&nbsp;MD Markus Scheibel PhD","doi":"10.1016/j.jse.2024.05.017","DOIUrl":"10.1016/j.jse.2024.05.017","url":null,"abstract":"<div><h3>Background</h3><div>The primary objective of this study was to evaluate and compare the incidence of complications and revision surgeries between in 2 of convertible metal-back glenoid systems in total shoulder arthroplasty (aTSA) groups over a follow-up period of up to 5 years.</div></div><div><h3>Methods</h3><div>A retrospective analysis included 69 shoulders from 65 patients with primary aTSA. Patients were divided into group 1 (n = 31), receiving convertible cementless stemmed aTSA (Lima SMR) and group 2 (n = 38), receiving humeral head replacement aTSA (Arthrex, Eclipse) both with metal-back glenoid components. Clinical and radiological assessments were conducted at 2, 5, and 10 years postoperatively. Assessments included the following: Constant Score, Disabilities of the Arm, Shoulder, and Hand, Shoulder Pain and Disability Index, Subjective Shoulder Value, Glenohumeral Distance, Critical Shoulder Angle, and Lateral Acromion Index. In addition, we compared complications, revision rates, and survival rates between groups using Kaplan-Maier curves and Log-Rank-test.</div></div><div><h3>Results</h3><div>Baseline demographics and preoperative outcome scores showed no significant differences between groups (<em>P</em> ≥ .05). The overall revision rate did not significantly differ between groups (group 1:32% vs. group 2:24%, <em>P</em> = .60), nor did the mean time to revision (<em>P</em> = .27). The mean follow-up was 71 ± 41 months (group 1: 94 ± 48 months, group 2: 53 ± 23 months, <em>P</em> &lt; .001). Kaplan-Meier analysis showed similar midterm survival probabilities (<em>P</em> = .94). Revision reasons included rotator cuff insufficiency (n = 4 in group 1, n = 2 in group 2) and glenoid wear/loosening (n = 5 in group 1, n = 7 in group 2). Interestingly, group 1 demonstrated no occurrence of glenoid metal baseplate or humeral loosening, while complex revisions were more common in the group 2. At 2 and 5 years, nonrevised patients in both groups had similar outcome scores.</div></div><div><h3>Conclusion</h3><div>Metal-backed glenoid implants in combination with both stemless and stemmed humeral components in aTSA exhibit comparable revision rates and survival probabilities. Rotator cuff insufficiency and polyethylene wear are the 2 most common complications leading to revision. To facilitate ongoing monitoring and optimize patient safety, we implemented a modification in the follow-up protocol, transitioning to annual appointments or earlier when necessary. This study underscores the unsolved disadvantages in metal-back components and the importance of a midterm to long-term longitudinal assessment of those patients.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages e72-e80"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acknowlegment to Reviewers","authors":"","doi":"10.1016/S1058-2746(24)00926-1","DOIUrl":"10.1016/S1058-2746(24)00926-1","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 650-669"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143175393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing pitch count is associated with increasing elbow flexion angle at ball release in youth baseball pitchers","authors":"Robert A. Cecere BS ,&nbsp;Matthew S. Fury MD ,&nbsp;Naya R. Lipkens BS ,&nbsp;Anna B. Williams BA ,&nbsp;Nathan E. Matzko BS ,&nbsp;Harrison N. White BS ,&nbsp;John Lama MS ,&nbsp;Jay Moran MD ,&nbsp;Stephen Fealy MD ,&nbsp;Joshua S. Dines MD ,&nbsp;Lawrence Gulotta MD ,&nbsp;Andreas Kontaxis PhD","doi":"10.1016/j.jse.2024.05.050","DOIUrl":"10.1016/j.jse.2024.05.050","url":null,"abstract":"<div><h3>Background</h3><div>Baseball is one of the most popular sports among youth athletes in the United States, and among these players, pitchers are at a particularly high risk of sustaining an injury. Overuse of the arm from repetitive pitching is a common mechanism for injury. Despite the attention that overuse injury has received, little is known regarding the mechanism that leads to elbow injury. This study aims to determine the effect of increasing pitch count on elbow flexion at ball release in a youth pitching cohort. The authors hypothesize that elbow flexion would increase as pitch count increases.</div></div><div><h3>Methods</h3><div>Study subjects included volunteers from youth baseball players from local teams and public advertisements. Retroreflective markers attached to bony landmarks were placed on the players according to International Shoulder Group recommendations. Pitchers threw an indoor simulated game. Three-dimensional marker trajectories were collected using a 12-camera optical motion capture system, and ball velocity was captured using a radar gun. Voluntary maximal isometric strength of the internal and external rotators was evaluated before and after pitching. Paired 2-tailed <em>t</em> tests were performed to determine if a significant change occurred between the fresh and fatigued sets.</div></div><div><h3>Results</h3><div>Twelve adolescent male pitchers were recruited. Eleven of 12 pitchers completed the prescribed 6 sets of 15 pitches, culminating in a 90-pitch simulated game. The ball speed in the second set was found to be the highest in all pitchers and was considered the “peak set” (<em>P</em> = .021), whereas ball speed was the slowest in the sixth set of pitches and was therefore considered the “fatigue set” (<em>P</em> = .001). There was a moderate but statistically significant inverse correlation between elbow flexion at ball release and maximum internal rotation velocity (<em>P</em> = .005). Elbow flexion at ball release was also significantly positively correlated with shoulder abduction at ball release (<em>P</em> = .004). Elbow flexion at ball release was not significantly correlated with ball velocity (<em>P</em> = .108).</div></div><div><h3>Conclusions</h3><div>In a simulated game laboratory setting, increasing pitch count was associated with increasing elbow flexion angle at ball release in youth baseball pitchers. These findings demonstrate that pitching with fatigue may cause biomechanical changes that have been associated with increased rates of elbow injury in the adult throwing population. Further investigation on the association between elbow flexion angle and elbow injury in the youth baseball population is needed.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 550-556"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does surgical intervention alter the natural history of degenerative rotator cuff tears? Comparative analysis from a prospective longitudinal study","authors":"J. Ryan Hill MD ,&nbsp;Jeffrey J. Olson MD ,&nbsp;Julianne A. Sefko MPH ,&nbsp;Karen Steger-May MA ,&nbsp;Sharlene A. Teefey MD ,&nbsp;William D. Middleton MD ,&nbsp;Jay D. Keener MD","doi":"10.1016/j.jse.2024.05.056","DOIUrl":"10.1016/j.jse.2024.05.056","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The natural history of rotator cuff tears often involves progressive pain development, tear enlargement, and advancing muscle fatty degeneration. Both surgery and conservative management have proven to be effective treatments. Our study purpose was to compare the short- to mid-term effects of rotator cuff repair on shoulder function, progression of tear size, and muscle degeneration compared to controls with asymptomatic tears that developed pain and were managed nonoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This comparative study consists of 2 separate longitudinal study arms. The control group consisted of asymptomatic degenerative cuff tears followed until pain development and then managed nonoperatively with continued surveillance. The surgical group consisted of subjects with degenerative tears that failed nonoperative treatment and underwent surgical intervention with a minimum of 2 years follow-up. Outcomes included visual analog scale pain, American Shoulder and Elbow Surgeons, active range of motion, strength, and ultrasonography.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;There were 83 controls and 65 surgical shoulders. The surgical group was younger at enrollment (58.9 ± 5.3 yr vs. 61.2 ± 7.8 yr, &lt;em&gt;P&lt;/em&gt; = .04). The median follow-up for control subjects after pain development was 5.1 years (interquartile range [IQR] 3.6) and the median postoperative follow-up for the surgical group was 3.0 years (IQR 0.2). Baseline tear widths (median 14 mm, IQR 9 vs. 13 mm, IQR 8; &lt;em&gt;P&lt;/em&gt; = .45) and tear lengths (median 14 mm, IQR 13 vs. median 11 mm, IQR 8; &lt;em&gt;P&lt;/em&gt; = .06) were similar between the surgical group and controls. There were no differences in the baseline prevalence of fatty degeneration of the supraspinatus or infraspinatus muscles between groups (&lt;em&gt;P&lt;/em&gt; = .43 and &lt;em&gt;P&lt;/em&gt; = .58, respectively). At final follow-up, the surgical group demonstrated significantly lower visual analog scale pain (0 [IQR 2] vs. 3.5 [IQR 4], &lt;em&gt;P&lt;/em&gt; = .0002), higher composite American Shoulder and Elbow Surgeons (95 [IQR 13] vs. 65.8 [IQR 32], &lt;em&gt;P&lt;/em&gt; = .0002), and activities of daily living scores (29 [IQR 4] vs. 22 [IQR 8], &lt;em&gt;P&lt;/em&gt; = .0002), greater abduction strength (69.6 N [standard deviation {SD} 29] vs. 35.9 N [SD 29], &lt;em&gt;P&lt;/em&gt; = .0002), greater active forward elevation (155° [SD 8] vs. 142° [SD 28], &lt;em&gt;P&lt;/em&gt; = .002), greater active external rotation in abduction (mean 98.5°, SD 12 vs. mean 78.2°, SD 20; &lt;em&gt;P&lt;/em&gt; = .0002) compared to controls. Additionally, the prevalence of fatty muscle degeneration was lower in the surgical group for the supraspinatus and infraspinatus (25% vs. 41%, &lt;em&gt;P&lt;/em&gt; = .05; 17% vs. 34%, &lt;em&gt;P&lt;/em&gt; = .03; respectively).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This prospective longitudinal study comparing a surgical cohort undergoing rotator cuff repair with a control group treated nonoperatively supports the notion that surgical intervention has the potential to alter ","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 430-440"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loose-fit vs. press-fit stems and risk for surgical reintervention following radial head arthroplasty: a US-based cohort study of 1575 patients","authors":"David W. Zeltser MD ,&nbsp;Kathryn E. Royse PhD ,&nbsp;Heather A. Prentice PhD ,&nbsp;Chelsea Reyes ,&nbsp;Elizabeth W. Paxton PhD ,&nbsp;Ronald A. Navarro MD ,&nbsp;Abtin Foroohar MD","doi":"10.1016/j.jse.2024.07.050","DOIUrl":"10.1016/j.jse.2024.07.050","url":null,"abstract":"<div><h3>Background</h3><div>Radial head arthroplasty (RHA) is performed with increasing frequency for reconstruction of comminuted radial head fractures. Implants can be categorized by stem design, either loose fit or press fit. Currently, the RHA literature does not suggest one implant type is superior to another based on revision and reoperation rates, although most RHA outcome studies have small numbers of patients with few events to detect a difference. This study evaluated the association between stem design and risk of revision and reoperation after RHA.</div></div><div><h3>Methods</h3><div>A total of 1575 patients aged ≥18 years who underwent primary RHA within a US-based health care system were identified (2009-2021). Revision following the index RHA was the primary outcome of interest; ipsilateral reoperation was a secondary outcome. Multivariable Cox proportional hazard regression was used to evaluate the risk of outcomes by loose vs. press fit with the adjustment for race and ethnicity, American Society of Anesthesiologists classification, region, surgeon RHA volume, and simultaneous ipsilateral extremity procedures.</div></div><div><h3>Results</h3><div>Of the 1575 RHAs, 681 (43.2%) received a loose-fit stem. The cumulative revision probability was 2.6% for loose fit and 3.5% for press fit. In adjusted analysis, we did not observe a difference in risk of revision (hazard ratio [HR] = 0.78, 95% confidence interval [CI] = 0.41-1.46) or reoperation (HR = 0.73, 95% CI = 0.43-1.25). Additionally, there were no observed differences in risk of revision (HR = 0.62, 95% CI = 0.28-1.38) or reoperation (HR = 0.90, 95% CI = 0.48-1.71) in the patient subgroup who underwent additional procedures in the same extremity at the time of RHA.</div></div><div><h3>Conclusion</h3><div>In this large multicenter cohort of 1575 primary RHAs, we did not observe a difference in risk of revision or reoperation following RHA based on stem design. The choice between using an implant with a loose- or press-fit stem may be based more on surgeon familiarity, implant availability, cost, and ease of use.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 516-524"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients undergoing reverse total shoulder arthroplasty have less pain and require fewer opioid pain medications compared to anatomic total shoulder arthroplasty in the early postoperative period: a retrospective review","authors":"Caleb A. Jones MD,&nbsp;Stephen Chambers MD,&nbsp;Andrew D. Renshaw BA,&nbsp;Thomas W. Throckmorton MD,&nbsp;David L. Bernholt MD,&nbsp;Frederick M. Azar MD,&nbsp;Tyler J. Brolin MD","doi":"10.1016/j.jse.2024.04.024","DOIUrl":"10.1016/j.jse.2024.04.024","url":null,"abstract":"<div><h3>Background</h3><div>Recovery after anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) has many similarities; however, recently surgeons have suggested patients undergoing rTSA have a less difficult postoperative course with less pain compared with aTSA patients. Given the heightened awareness to postoperative pain control and opioid consumption, as well as the expanding indications for rTSA, we sought to determine the differences in pain and opioid consumption between aTSA and rTSA patients in a 12-week postoperative period.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed to identify all patients who underwent a primary aTSA or rTSA from January 2013 to April 2018 at a single institution. Patients with recorded visual analog scale (VAS) and American Shoulder and Elbow Surgeons scores were included for analysis. Revision arthroplasties were excluded. VAS scores were recorded preoperatively and at standard 2-week, 6-week, and 12-week postoperative time points. <em>P</em> values &lt; .05 were considered statistically significant, except where Bonferroni corrections were applied.</div></div><div><h3>Results</h3><div>A total of 690 patients underwent TSA (278 aTSA, 412 rTSA). Preoperatively, aTSA and rTSA patient groups had similar VAS scores (6 vs. 6, <em>P</em> = .38). Postoperatively, the aTSA group had a higher VAS at the 6-week visit, compared with rTSA patients (2.8 vs. 2.2, <em>P</em> = .003). aTSA patients remained on opioids at a higher rate at the 2-week (62.4% vs. 45.6%, <em>P</em> ≤ .001) time period. aTSA patients needed more opioid prescription refills before the 2-week (61.7% vs. 45.5%, <em>P</em> ≤ .001) and 6-week (40.4% vs. 30.7%, <em>P</em> = .01) follow-up visits.</div></div><div><h3>Conclusions</h3><div>Despite similar preoperative VAS and rates of preoperative opioid use, aTSA patients required more opioid medication refills and remained on opioids for a longer duration in the early postoperative period to achieve similar postoperative pain control as indicated by similar VAS. This study suggests that the recovery from rTSA is less difficult compared with aTSA as indicated by VAS and opioid consumption.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 454-461"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Augmented reality–assisted intraoperative navigation increases precision of glenoid inclination in reverse shoulder arthroplasty","authors":"Rony-Orijit Dey Hazra MD,&nbsp;Alp Paksoy MD,&nbsp;Jan-Philipp Imiolczyk MD,&nbsp;Henry Gebauer MD,&nbsp;Agahan Hayta MD,&nbsp;Doruk Akgun MD","doi":"10.1016/j.jse.2024.05.039","DOIUrl":"10.1016/j.jse.2024.05.039","url":null,"abstract":"<div><h3>Background</h3><div>Reverse total shoulder arthroplasty (RTSA) is the standard of care for patients with glenohumeral osteoarthritis and rotator cuff deficiency. Preoperative RTSA planning based on medical images and patient-specific instruments has been established over the last decade. This study aims to determine the effects of using augmented reality–assisted intraoperative navigation (ARIN) for baseplate positioning in RTSA compared to preoperative planning. It is hypothesized that ARIN will decrease deviation between preoperative planning and postoperative baseplate positioning. Moreover, ARIN will decrease deviation between the (senior) more (&gt;50 RTSAs/yr) and less experienced (junior) surgeon (5-10 RTSAs/yr).</div></div><div><h3>Methods</h3><div>Preoperative CT scans of 16 fresh-frozen cadaveric shoulders were obtained. Baseplate placements were planned using a validated software. The data were then converted and uploaded to the augmented reality system (NextAR; Medacta International). Each of the 8 RTSAs were implanted by a senior and a junior surgeon, with 4 RTSAs using ARIN and 4 without. A postoperative CT scan was performed in all cases. The scanned scapulae were segmented, and the preoperative scan was laid over the postoperative scapula by the nearest iterative point cloud analysis. The deviation from the planned entry point and trajectory was calculated regarding the inclination, retroversion, medialization (reaming depth) and lateralization, anteroposterior position, and superoinferior position of the baseplate. Data are reported as mean ± standard deviation (SD) or mean and 95% confidence interval (CI). <em>P</em> values &lt; .05 were considered statistically significant.</div></div><div><h3>Results</h3><div>The use of ARIN yielded a reduction in the absolute difference between planned and obtained inclination from 9° (SD: 4°) to 3° (SD: 2°) (<em>P</em> = .011). Mean difference in planned-obtained inclination between surgeons was 3° in free-hand surgeries (95% CI: −4 to 10; <em>P</em> = .578), whereas this difference reduced to 1° (95% CI: −6 to 7, <em>P</em> = .996) using ARIN. Retroversion, medialization (reaming depth) and lateralization, anteroposterior position, and superoinferior position of the baseplate were not affected by using ARIN. Surgical duration was increased using ARIN for both the senior (10 minutes) and junior (18 minutes) surgeon.</div></div><div><h3>Conclusions</h3><div>The implementation of ARIN leads to greater accuracy of glenoid component placement, specifically with respect to inclination. Further studies have to verify if this increased accuracy is clinically important. Furthermore, ARIN allows less experienced surgeons to achieve a similar level of accuracy in component placement comparable to more experienced surgeons. However, the potential advantages of ARIN in RTSA are counterbalanced by an increase in operative time.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 577-583"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of age-related bone density changes on primary stability in stemless shoulder arthroplasty: a multi-implant finite element study","authors":"Helena Líbano Monteiro MSc ,&nbsp;Madalena Antunes MEng ,&nbsp;Marco Sarmento MD, PhD ,&nbsp;Carlos Quental PhD ,&nbsp;João Folgado PhD","doi":"10.1016/j.jse.2024.04.013","DOIUrl":"10.1016/j.jse.2024.04.013","url":null,"abstract":"<div><h3>Background</h3><div>Stemless implants were introduced to prevent some of the stem-related complications associated with the total shoulder arthroplasty. Although general requirements for receiving these implants include good bone quality conditions, little knowledge exists about how bone quality affects implant performance. The goal of this study was to evaluate the influence of age-induced changes in bone density, as a metric of bone quality, in the primary stability of five anatomic stemless shoulder implants using three-dimensional finite element (FE) models.</div></div><div><h3>Methods</h3><div>The implant designs considered were based on the Global Icon, Sidus, Simpliciti, SMR, and Inhance stemless implants. Shoulder arthroplasties were virtually simulated in Solidworks. The density distributions of 20 subjects from two age groups, 20-40 and 60-80 years old, were retrieved from medical image data and integrated into three-dimensional FE models of a single humerus geometry, developed in Abaqus, to avoid confounding factors associated with geometric characteristics. For the designs which do not have a solid collar covering the entire bone surface, ie, the Sidus, Simpliciti, SMR, and Inhance implants, contact and noncontact conditions between the humeral head component and bone were considered. Primary stability was evaluated through the assessment of micromotions at the bone-implant interface considering eight load cases related to rehabilitation activities and demanding tasks. Three research variables, considering 20 μm, 50 μm, and 150 μm as thresholds for osseointegration, were used for a statistical analysis of the results.</div></div><div><h3>Results</h3><div>The decreased bone density registered for the 60-80 age group led to larger micromotions at the bone-implant interface when compared to the 20-40 age group. The Global Icon-based and Inhance-based designs were the least sensitive to bone density, whereas the Sidus-based design was the most sensitive to bone density. The establishment of contact between the humeral head component and bone for the implants that do not have a solid collar led to decreased micromotions.</div></div><div><h3>Discussion</h3><div>Although the age-induced decline in bone density led to increased micromotions in the FE models, some stemless shoulder implants presented good overall performance regardless of the osseointegration threshold considered, suggesting that age alone may not be a contraindication to anatomic total shoulder arthroplasty. If only primary stability is considered, the results suggested superior performance for the Global Icon-based and Inhance-based designs. Moreover, the humeral head component should contact the resected bone surface when feasible. Further investigation is necessary to combine these results with the long-term performance of the implants and allow more precise recommendations.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"34 2","pages":"Pages 557-566"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}