Journal of Shoulder and Elbow Surgery最新文献

{"title":"Corrigendum to ‘Return to sport after arthroscopic xenograft bone block associated with Bankart repair and subscapularis augmentation in competitive contact athletes with recurrent anterior shoulder instability’ [Journal of Shoulder and Elbow Surgery (2025) e954]","authors":"Raffaele Russo MD , Alberto Fontanarosa MD , Marco Montemagno MD , Alfonso Fedele MD , Angelo De Crescenzo MD , Francesco Di Pietto MD , Roberto Calbi MD , Raffaele Garofalo MD","doi":"10.1016/j.jse.2025.10.001","DOIUrl":"10.1016/j.jse.2025.10.001","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Page e522"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483654","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 4-screw vs. nonaugmented 6-screw PHILOS plating in low-bone quality proximal humerus fractures: a biomechanical human cadaveric study","authors":"Fabian Pretz MD ,&nbsp;Frank J.P. Beeres MD, PhD (Prof) ,&nbsp;Björn-Christian Link MD, PD ,&nbsp;Yannic Lecoultre MD ,&nbsp;Reto Babst MD (Prof) ,&nbsp;Boyko Gueorguiev PhD (Prof) ,&nbsp;Peter Varga PhD, PD ,&nbsp;Bryan J.M. van de Wall MD, PhD, PD ,&nbsp;Ivan Zderic PhD ,&nbsp;Torsten Pastor MD, PhD, PD","doi":"10.1016/j.jse.2025.07.006","DOIUrl":"10.1016/j.jse.2025.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Proximal humerus fractures are frequent in patients with low bone quality. PHILOS plates are widely used with either minimally invasive plate osteosynthesis (MIPO) or open reduction and internal fixation (ORIF) techniques. However, it remains unclear whether plating with 4 cement-augmented proximal screws provides biomechanical stability comparable to using 4 nonaugmented proximal screws plus 2 additional calcar screws in unstable low bone quality proximal humerus fractures.</div></div><div><h3>Methods</h3><div>Fourteen paired human cadaveric humeri with low bone quality and simulated unstable 3-part proximal humerus fractures (AO 11-B1) were assigned to 2 groups – 4S+ and 6S – and stabilized using PHILOS plates with 4 proximal head screws in both groups. In the 6S group, 2 additional calcar (inferomedial support) screws were used, whereas in the 4S+ group, the 4 screw tips were augmented with bone cement. Cyclic axial loading tests were conducted until failure. Interfragmentary movements were monitored via motion tracking.</div></div><div><h3>Results</h3><div>Initial axial construct stiffness and cycles to failure showed no significant differences between groups (<em>P</em> = .171, <em>P</em> = .397). Although interfragmentary movements were slightly higher in the 4S+ group, this difference was not significant (<em>P</em> ≥ .071). Under cyclic loading, the 6S group exhibited a significant progressive increase over cycles for varus deformation (<em>P</em> = .029), humeral head displacement (<em>P</em> = .038), and screw bending in row A (<em>P</em> = .003), whereas no significant increase over cycles was observed in the 4S+ group and between the groups.</div></div><div><h3>Conclusion</h3><div>From a biomechanical perspective, PHILOS plating with 4 cement-augmented screws demonstrated comparable stability versus plating with 4 nonaugmented head screws plus 2 additional calcar screws, suggesting that the former fixation technique represents a valid alternative to the latter, particularly in case of low bone quality.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 765-774"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976656","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":"Use of tranexamic acid reduces opioid consumption after arthroscopic rotator cuff repair","authors":"Katherine A. Burns MD ,&nbsp;Lynn M. Robbins PA-C ,&nbsp;Laura A. Humphrey PA-C ,&nbsp;Angela R. LeMarr RN, BSN, ONC ,&nbsp;Diane J. Morton MS, MWC ,&nbsp;Melissa L. Wilson MPH, PhD","doi":"10.1016/j.jse.2025.07.023","DOIUrl":"10.1016/j.jse.2025.07.023","url":null,"abstract":"<div><h3>Background</h3><div>Tranexamic acid (TXA) is an antifibrinolytic agent that has effectively reduced transfusion risk and minimized blood loss after total joint arthroplasty. TXA use has had mixed results on postoperative pain after arthroscopic rotator cuff repair (ARCR). The purpose of this prospective, double-blind, randomized, controlled trial was to examine the impact of TXA on prescription opioid consumption for 3 postoperative days in an outpatient population after ARCR. Intraoperative visualization and postoperative pain scores also were collected.</div></div><div><h3>Methods</h3><div>Patients scheduled to have ARCR with one surgeon at one institution were eligible for inclusion in a prospective, double-blind, randomized, and placebo-controlled trial comparing a cohort receiving intravenous administration of TXA 1,000 mg with a cohort receiving an equivalent volume of intravenous saline. The primary outcome was opioid consumption as measured by morphine milligram equivalents for the first 3 days after surgery. The secondary outcome was subjective measurement of pain as measured by the visual analog scale for the first 3 days after surgery.</div></div><div><h3>Results</h3><div>A total of 165 patients were enrolled, with 82 patients in the TXA group and 81 in placebo after 2 exclusions. No significant differences between groups were found for age, race, sex, size of rotator cuff tear, number of anchors used, or modifiable risk factors including preoperative opioid use and smoking tobacco status. TXA use independently reduced opioid consumption significantly for the first 3 days after ARCR by 18 morphine milligram equivalents (<span><math><mrow><mi>β</mi></mrow></math></span> = −18.0 [−35.4, −0.5], <em>P</em> = .044). Age also affected opioid use, with older patients consuming slightly less opioid than younger patients per year of age (<span><math><mrow><mi>β</mi></mrow></math></span> = −1.5 [−2.5, −0.5], <em>P</em> = .003). Factors that significantly increased opioid use included prior opioid use (<span><math><mrow><mi>β</mi></mrow></math></span> = 64.2 [32.0, 96.3], <em>P</em> &lt; .001) and increasing number of anchors used (per anchor, <span><math><mrow><mi>β</mi></mrow></math></span> = 7.9 [4.0, 11.7], <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>TXA use significantly reduced opioid consumption after ARCR. Advancing age modulated postoperative opioid consumption, whereas preoperative opioid use and number of anchors used increased opioid consumption in the first 3 days after ARCR. No differences were found in subjective pain score as measured by visual analog scale for the first 3 days after ARCR.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 757-764"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001867","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 prophylactic antibiotic choice for total shoulder arthroplasty matter? A matched cohort analysis","authors":"Tej Joshi MD ,&nbsp;Akhil Katakam MD ,&nbsp;Daniel Calem MD ,&nbsp;Daniella Ogilvie MD ,&nbsp;Eitan M. Kohan MD ,&nbsp;Francis G. Alberta MD","doi":"10.1016/j.jse.2025.07.017","DOIUrl":"10.1016/j.jse.2025.07.017","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infection (PJI) of the shoulder is a devastating complication following total shoulder arthroplasty (TSA). The majority of literature regarding antibiotic choice for TSA is from accompanying literature in other orthopedic subspecialties. The purpose of this study was to delineate the relationship between various perioperative antibiotics, including local, topical vancomycin, and their potential protective effect on PJI following shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the TriNetX database to identify 28,098 patients who underwent TSA. Patients were stratified into cohorts based on the type of prophylactic antibiotic received in the perioperative period–only cefazolin, noncefazolin prophylaxis, vancomycin only, cefazolin with any form of vancomycin, cefazolin with topical vancomycin, only clindamycin, and cefazolin with clindamycin. The later 6 cohorts were one-to-one propensity score matched with the cefazolin-only cohort for risk analysis. The 90-day and 2-year risk of PJI and revision was analyzed, in addition to other surgical, hospital readmission, or emergency department visit complications.</div></div><div><h3>Results</h3><div>At 2 years, cefazolin monotherapy was associated with a significantly lower incidence of prosthetic joint infection and overall infection than noncefazolin regimens. No significant differences were found when cefazolin was compared with vancomycin alone or clindamycin alone. Adding local vancomycin did not significantly reduce the risk of PJI at any time point. Secondary antibiotic prophylaxis in addition to cefazolin was not associated with a decreased risk of infection at any time point.</div></div><div><h3>Conclusion</h3><div>Antibiotic prophylaxis choice for TSA may vary based on the surgeon's preference. Noncefazolin prophylaxis may not provide the same protection against PJI and overall infection as cefazolin prophylaxis. Cefazolin monotherapy is associated with lower infection rates compared to other noncefazolin regimens, suggesting that cefazolin should be used preferentially. However, prospective trials are required to further elucidate this finding.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 704-712"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976678","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":"Preoperative testosterone replacement therapy is associated with increased rates of periprosthetic joint infection, acute kidney injury, and emergency department utilization after total shoulder arthroplasty: a propensity-score matched analysis","authors":"Alexander E. White MD ,&nbsp;Argen Omurzakov BA ,&nbsp;Arsen M. Omurzakov BA ,&nbsp;Christian E. Athanasian BA ,&nbsp;Christopher M. Brusalis MD ,&nbsp;Michelle E. Kew MD ,&nbsp;Michael C. Fu MD ,&nbsp;Lawrence V. Gulotta MD ,&nbsp;Samuel A. Taylor MD","doi":"10.1016/j.jse.2025.07.022","DOIUrl":"10.1016/j.jse.2025.07.022","url":null,"abstract":"<div><h3>Background</h3><div>The use of testosterone replacement therapy (TRT) has increased in recent years; however, its effect on surgical outcomes and long-term implant survival in total shoulder arthroplasty (TSA) remains unclear. This study aimed to assess the association between preoperative TRT and postoperative complications following TSA.</div></div><div><h3>Methods</h3><div>The TriNetX database was queried to identify patients undergoing TSA before 2020. Patients were then stratified based on preoperative TRT within 1 year before surgery. Propensity score matching was performed in a 1:1 ratio to balance demographic variables and comorbidities. Outcomes assessed included 90-day and 1-year medical and implant complications and 5-year implant complications. Statistical analyses were performed using TriNetX's built-in analytics platform.</div></div><div><h3>Results</h3><div>Following propensity score matching, 1,369 patients were included in each cohort and no baseline differences were detected. At 90 days postoperatively, TRT patients had significantly higher rates of emergency department (ED) visits (13.7% vs. 8.1%, risk ratio [RR]: 1.69, <em>P</em> &lt; .001). At 1 year, TRT patients demonstrated increased rates of ED utilization (26.6% vs. 16.9%, RR: 1.58, <em>P</em> &lt; .001), acute kidney injury (17.5% vs. 12.1%, RR: 1.45, <em>P</em> &lt; .001), and periprosthetic joint infection (PJI) (4.8% vs. 2.4%, RR: 2.00, <em>P</em> &lt; .001). At 5 years, TRT was associated with increased rates of PJI (7.9% vs. 4.5%, RR: 1.74, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Preoperative TRT is associated with an increased risk of PJI, acute kidney injury, and postoperative ED visits following TSA. These findings highlight the need for careful preoperative risk assessment and patient counseling when considering TSA in patients on TRT.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 689-696"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994343","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 Baek et al. regarding: “Machine learning models can define clinically relevant bone density subgroups based on patient-specific calibrated computed tomography scans in patients undergoing reverse shoulder arthroplasty”","authors":"Daniel Ritter MSc,&nbsp;Patrick J. Denard MD,&nbsp;Patric Raiss MD,&nbsp;Brian C. Werner MD,&nbsp;Asheesh Bedi MD,&nbsp;Samuel Bachmaier MSc","doi":"10.1016/j.jse.2025.07.034","DOIUrl":"10.1016/j.jse.2025.07.034","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages e518-e520"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055384","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":"Radiological and electrodiagnostic insights into suprascapular nerve dysfunction: a key predictor of poor functional outcomes in shoulder hemiarthroplasty","authors":"Ahmet Keskin MD ,&nbsp;Niyazi Iğde MD ,&nbsp;Bülent Karslıoğlu MD ,&nbsp;Fethi Mıhlayanlar MD ,&nbsp;Onur Akan MD ,&nbsp;Ahmet Akçay MD ,&nbsp;Yunus İmren MD ,&nbsp;Süleyman Semih Dedeoğlu MD","doi":"10.1016/j.jse.2025.07.001","DOIUrl":"10.1016/j.jse.2025.07.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Suprascapular nerve (SSN) dysfunction has emerged as an underexplored factor influencing functional outcomes after shoulder hemiarthroplasty (SHA) for proximal humerus fractures. Despite achieving optimal tuberosity healing and prosthesis alignment, some patients continue to experience poor functional recovery. This study investigates the role of SSN dysfunction as a key determinant of unfavorable outcomes following SHA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This retrospective study analyzed 38 patients who underwent SHA for Neer type III or IV proximal humerus fractures. Inclusion criteria included radiographic confirmation of tuberosity healing, absence of pre-existing rotator cuff tears, and sufficient follow-up. Patients were divided into 2 groups based on the Constant Shoulder Score (CSS) at 12 months postoperatively: group G (good outcomes, CSS difference between prosthetic and healthy shoulders &lt;30) and group P (poor outcomes, CSS difference ≥30). Electrophysiologicalassessments were performed bilaterally to evaluate SSN function. Compound muscle action potentials and needle electromyography were used to measure nerve conduction and detect chronic neurogenic changes. Bilateral ultrasound imaging quantified supraspinatus muscle thickness at medial, central, and lateral points. These measurements provided a detailed comparison of prosthetic and healthy shoulders, identifying patterns of nerve dysfunction and muscle atrophy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Group P exhibited significantly lower American Shoulder and Elbow Surgeons scores, higher visual analog scale scores, and reduced shoulder motion (&lt;em&gt;P&lt;/em&gt; &lt; .01 for all). Findings revealed significantly lower compound muscle action potential amplitudes in the prosthetic shoulder of group P (2.55 ± 0.42 mV) compared with the prosthetic shoulders of healthy side (4.82 ± 0.67 mV, &lt;em&gt;P&lt;/em&gt; &lt; .001) and group G (4.27 ± 0.55 mV, &lt;em&gt;P&lt;/em&gt; &lt; .001). Reductions in amplitude exceeded 50% on the prosthetic side for group P. Needle electromyography of prosthetic shoulders in group P demonstrated chronic neurogenic changes, including fibrillation potentials and polyphasic motor unit potentials, in the supraspinatus and infraspinatus muscles. Ultrasound measurements revealed significant supraspinatus muscle atrophy on the prosthetic side in group P, with medial thickness reduction identified as the strongest predictor of poor outcomes (odds ratio = 1.312, 95% confidence interval: 1.042-1.654, &lt;em&gt;P&lt;/em&gt; = .021). Healthy shoulders in group P exhibited no significant neurogenic abnormalities, highlighting localized dysfunction in the prosthetic side.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;SSN dysfunction, evidenced by reduced nerve amplitudes and supraspinatus muscle atrophy, significantly predicts poor functional outcomes following SHA, even when tuberosities are well healed. These findings highlight the importance of perioperative nerve preservation stra","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 719-730"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862636","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":"Prognostic value of baseline muscle strength for functional recovery after rotator cuff repair: an observational study","authors":"Serghio Torreblanca-Vargas MSc ,&nbsp;Joaquín Salazar-Méndez MSc ,&nbsp;Héctor Gutiérrez-Espinoza PhD ,&nbsp;Rodrigo de Marinis MD ,&nbsp;Rodrigo Núñez-Cortés PhD","doi":"10.1016/j.jse.2025.07.010","DOIUrl":"10.1016/j.jse.2025.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Although arthroscopic surgery restores tendon integrity and shoulder mechanics, the persistence of symptoms in some patients highlights the need to identify factors that influence rehabilitation outcomes. The aim of this study was to analyze the relationship between baseline muscle strength, assessed at the start of rehabilitation (6 weeks postoperatively), and clinical recovery at 3 and 6 months in patients undergoing arthroscopic rotator cuff repair.</div></div><div><h3>Methods</h3><div>From 2023 to 2024, a total of 76 participants undergoing arthroscopic rotator cuff repair were recruited consecutively and prospectively. Multivariable linear regression analysis was used to determine the association of each potential predictor (ipsilateral handgrip strength, contralateral handgrip strength, asymmetry of handgrip strength, and shoulder ipsilateral rotational strength) with functional outcomes at 3 and 6 months after surgery (Disabilities of the Arm, Shoulder, and Hand [DASH], Constant-Murley questionnaires, and visual analog scale [VAS]), controlling for various covariates.</div></div><div><h3>Results</h3><div>Seventy-six participants were included. Baseline handgrip strength in both the ipsilateral and contralateral limb was significantly associated with better functional outcomes at 3 and 6 months after surgery. Specifically at 6 months, greater contralateral handgrip strength was associated with better Constant-Murley scores (β: 0.36, 95% confidence interval [CI]: 0.10-0.62; <em>P</em> = .007), and greater asymmetry in handgrip strength was significantly associated with worse Constant-Murley scores (β: −0.63, 95% CI: −1.13 to −0.13; <em>P</em> = .014). Additionally, greater ipsilateral handgrip strength was significantly associated with lower pain scores (β: −0.28, 95% CI: −0.51 to −0.04; <em>P</em> = .022). Interestingly, shoulder rotational strength was not associated with functional outcomes.</div></div><div><h3>Conclusions</h3><div>Early strength assessment was significantly associated with clinical recovery in patients undergoing rotator cuff repair. These findings highlight the potential clinical utility of bilateral handgrip strength assessments in guiding rehabilitation strategies after rotator cuff repair.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 749-756"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976309","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":"Comparison of patient-specific instrumentation, navigation, and mixed reality technologies for accurate glenoid positioning in reverse total shoulder arthroplasty: a systematic review and meta-analysis","authors":"DongHwan Lee MD ,&nbsp;Jiseung Yoo MD ,&nbsp;Jong Pil Yoon MD, PhD ,&nbsp;Kyung-Soo Oh MD, PhD ,&nbsp;Seok Won Chung MD, PhD","doi":"10.1016/j.jse.2025.07.019","DOIUrl":"10.1016/j.jse.2025.07.019","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to compare the accuracy of glenoid implant positioning achieved using emerging technologies, including patient-specific instrumentation (PSI), surgical navigation (NAV), and mixed reality (MR) in reverse total shoulder arthroplasty (rTSA).</div></div><div><h3>Methods</h3><div>A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing the PubMed, Scopus, and EMBASE databases to identify English-language original studies. Studies meeting predefined inclusion and exclusion criteria were selected to evaluate glenoid implant positioning in rTSA using PSI, NAV, and MR techniques. A meta-analysis was performed, incorporating both cadaveric and clinical studies, to analyze radiologic outcomes based on deviations from preoperative planning. Radiologic assessments included comparisons of version, inclination, and entry point offset across techniques. The outcomes of glenoid component positioning were analyzed using a random-effects model with the restricted maximum likelihood estimator.</div></div><div><h3>Results</h3><div>Out of 2,794 articles identified, 14 met the inclusion criteria for the systematic review. The analysis included both clinical and cadaveric studies for PSI and NAV techniques. PSI and NAV showed reduced deviations in version and inclination compared to the conventional method (CON). Statistical significance was observed only for inclination between PSI and CON (<em>P</em> = .030), and for both version and inclination between NAV and CON (all <em>P</em> &lt; .001). When comparing PSI and NAV, PSI demonstrated significantly lower deviations in version and inclination (all <em>P</em> &lt; .001). For MR, only cadaveric studies were available for analysis. In comparisons between MR and NAV, MR showed significantly lower deviations in version and inclination (all <em>P</em> &lt; .001). However, when comparing MR and PSI, mixed results were observed: MR had lower deviations in version and inclination, while PSI showed lower deviations in entry point offset (all <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Both PSI and NAV methods demonstrated improved accuracy compared to the CON method, with PSI showing superior accuracy and smaller deviations than NAV. While limited to cadaveric studies, MR showed greater accuracy than NAV but produced mixed results when compared to PSI. Further clinical studies on MR are needed to validate and generalize these findings.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 849-863"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994189","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":"Annual hospital surgical volume and patient medical complexity affect length of stay for rTSA but not overall risk of complications following TSA, rTSA, and revision TSA","authors":"Dylan N. Greif MD ,&nbsp;Patrick Castle MD ,&nbsp;Gabriel Ramirez MS ,&nbsp;Caroline Thirukumaran MBBS, MHA, PhD ,&nbsp;Ilya Voloshin MD ,&nbsp;Sandeep Mannava MD, PhD","doi":"10.1016/j.jse.2025.07.021","DOIUrl":"10.1016/j.jse.2025.07.021","url":null,"abstract":"<div><h3>Background</h3><div>Total shoulder arthroplasty (TSA) volume has significantly increased over the last several decades, especially in the outpatient setting. Performing TSA in lower volume hospital facilities may offset demand, especially when treating medically complex patients. The purpose of this study is to assess the association of annual hospital volume and patient medical complexity with postoperative complications, readmissions, and length of stay (LOS) in patients undergoing TSA, reverse total shoulder arthroplasty (rTSA), and revision TSA.</div></div><div><h3>Methods</h3><div>The 2016-2022 Statewide Planning and Research Cooperative System Database (an all-payer dataset within New York State) was used to query demographic information, procedure type, outcomes/complications, and LOS for patients who underwent the above procedures. Hospital volume was divided into quartiles, with quartile four the highest performing. Multivariable logistic regression was performed to determine the association of hospital volume with odds of complications (including related readmissions) or LOS. Elixhauser Comorbidity Sum was used to categorize medical complexity.</div></div><div><h3>Results</h3><div>There were 11,388 anatomic total shoulder arthroplasty (aTSA), 19,328 rTSA, and 95 primary revision TSA patients. LOS decreased by up to one and 2 days respectively on average with increasing hospital volume in TSA and rTSA patients. Logistic regression demonstrated that odds of complication in patients undergoing aTSA were not affected by hospital volume, yet LOS increased in lower quartile facilities (1.38, <em>P</em> &lt; .05). For revision TSA, there was no clinical or statistical difference in LOS and composite complications regardless of hospital volume. When comparing the probability of re-admission or post-surgical complication based on Elixhauser Comorbidity Sum (value ≥ 2) and annual hospital volume, only LOS in rTSA patients was adversely affected by lower volume facilities (1.68, <em>P</em> &lt; .05), with lower volume facilities having a longer LOS.</div></div><div><h3>Discussion</h3><div>The odds of readmission or postoperative complication ar similar across facilities of varying annual surgical volume. Only LOS for rTSA patients appeared to be adversely affected based on annual hospital volume. Performance of revision shoulder arthroplasty at higher volume facilities warrants further study. Overall, aTSA and rTSA are safe procedures and with proper medical management can be performed in facilities of varying annual volume.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 872-882"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994260","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}