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IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery

Pub Date : 2026-03-01 Epub Date: 2026-02-06 DOI: 10.1016/S1058-2746(26)00011-X

引用次数: 0

Cost-effectiveness of open biceps tenodesis for superior labral tears in patients younger than 30 years: a Markov analysis 开放肱二头肌肌腱固定术治疗30岁以下患者上唇撕裂的成本-效果：马尔科夫分析。

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery

Pub Date : 2026-03-01 Epub Date: 2025-08-14 DOI: 10.1016/j.jse.2025.06.027

Eoghan T. Hurley MB, MCh, PhD, Jacob F. Oeding PhD, Mark A. Glover MD, Alex M. Meyer MD, James A. Pruneski MD, Jennifer L. Smith MD, James Bailey MD, Brian R. Waterman MD, Brian C. Lau MD, Jon F. Dickens MD

Background

Biceps tenodesis (BT) has emerged as an alternative to arthroscopic labral repair (ALR) in younger patients with superior labral anterior-posterior (SLAP) tears. The purpose of this study is to perform a Markov model–based cost-effectiveness analysis comparing BT to ALR for symptomatic SLAP tears in patients <30 years old, using return to play (RTP) as the primary measure of surgical utility.

Methods

Both deterministic and Markov-chain Monte Carlo probabilistic models were developed to evaluate the outcomes and costs of 100 simulated patients (<30 years old) undergoing BT vs. ALR for symptomatic, SLAP tears. Surgical failure rates, RTP rates, and costs were derived from the published literature and varied through probabilistic sensitivity analyses. Outcome measures included costs, acquired duty years (DYs; annual participation in full physical activity—including sport, military service, or occupational work—without the limitations imposed by revision surgery or treatment failure), and the incremental cost-effectiveness ratio. Ten-year costs for each patient in the microsimulation model were averaged by initial treatment strategy, capturing subsequent treatments patients underwent because of reoperation.

Results

Over the 10-year time horizon, results from the deterministic model demonstrated total costs resulting from BT and ALR of $35,402 and $40,960, respectively. In addition, BT was associated with 5.39 DYs gained, compared with 5.05 DYs gained for ALR. These results were replicated in the probabilistic model, demonstrating BT to be the preferred, cost-effective treatment strategy, with both lower costs and higher DYs acquired as a result of undergoing BT.

Conclusion

Results of both the deterministic model and Monte Carlo microsimulation and probabilistic sensitivity analysis demonstrated BT to be the dominant, cost-effective treatment strategy for symptomatic SLAP tears in patients <30 years of age, measured via both lower costs and significant, but marginally higher, DYs.

背景：二头肌肌腱固定术（BT）已成为关节镜下唇部修复（ALR）的替代方法，用于年轻的上唇前后（SLAP）撕裂患者。本研究的目的是对30岁以下的患者进行基于马尔科夫模型的成本-效果分析，比较BT和ALR治疗有症状的SLAP撕裂，以恢复比赛（RTP）作为手术效用的主要衡量标准。方法：建立确定性和马尔可夫链蒙特卡罗概率模型来评估100名模拟患者的结果和成本（结果：在10年的时间范围内，确定性模型的结果显示BT和ALR的总成本分别为35,402美元和40,960美元）。此外，BT增加了5.39日龄，而ALR增加了5.05日龄。这些结果在概率模型中得到了重复，表明BT是首选的、具有成本效益的治疗策略，因为接受BT治疗既降低了成本，又提高了每日治疗时间。确定性模型和蒙特卡罗微观模拟以及概率敏感性分析的结果表明，BT是30岁以下患者有症状的SLAP撕裂的主要、经济有效的治疗策略，通过较低的成本和显著但略高的DYs来衡量。证据等级:三级;经济研究。

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引用次数: 0

Using percentage of maximal possible improvement to predict high patient satisfaction following the Latarjet procedure 使用最大可能改善百分比（MPI）预测Latarjet手术后患者的高满意度。

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery

Pub Date : 2026-03-01 Epub Date: 2025-08-25 DOI: 10.1016/j.jse.2025.07.013

Brian O. Molokwu MS, Jacquelyn J. Xu MA, Nathaniel P. Mercer MD, Tanzeel Sultan BS, C. Lucas Myerson MD, Jie J. Yao MD, Robert J. Meislin MD, Mandeep S. Virk MD

Background

Outcome thresholds such as the minimal clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit are commonly used to define meaningful clinical improvement. However, these measures apply uniform cutoffs that do not account for individual baseline scores. Maximal possible improvement (MPI) offers a patient-specific approach by considering the maximal potential gain in function or reduction in pain. The percentage of MPI (%MPI) that correlates with high postoperative patient satisfaction following the Latarjet procedure (LP) has not been defined. The purpose of this study was to (1) establish %MPI thresholds predictive of high patient satisfaction for the American Shoulder and Elbow Surgeons (ASES) score and the Patient-Reported Outcomes Measurement Information System domains of upper extremity function (PUE), Pain Interference (P-Interference), and Pain Intensity (P-Intensity); and (2) identify patient-level factors associated with achieving these thresholds for ASES and PUE.

Methods

A retrospective review identified 81 eligible patients who underwent the LP with a minimum 1-year follow-up. Preoperative and postoperative ASES, PUE, P-Interference, and P-Intensity scores, along with postoperative patient degree of satisfaction, were recorded. Receiver operating characteristic curve analyses were performed to identify individual %MPI thresholds in each of the 4 scores that best predicted high satisfaction at minimum 1 year postoperatively. Univariate and multivariate logistic regression analyses were conducted sequentially to identify patient factors that were associated with achievement of the ASES and PUE thresholds.

Results

Among the 81 patients who met the inclusion criteria, the %MPI thresholds associated with high satisfaction were 65% for ASES (area under the curve [AUC]: 0.86), 29% for PUE (AUC: 0.84), 57% for P-Interference (AUC: 0.78), and 59% for P-Intensity (AUC: 0.77). Higher body mass index (odds ratio [OR]: 1.16, P = .048) and surgery on the dominant arm (OR: 3.87, P = .024) were associated with higher odds of achieving the ASES threshold. Recurrent dislocations preoperatively (OR: 0.20, P = .022) were associated with lower odds of achieving the PUE threshold.

Conclusion

The %MPI following the LP offers an individualized measure of clinical success and accounts for baseline variability and mitigates ceiling effects. Thresholds associated with high patient satisfaction following the LP were ≥65% for ASES, ≥29% for PUE, ≥57% for P-Interference, and ≥59% for P-Intensity.

结果阈值，如最小临床重要差异（MCID）、患者可接受症状状态（PASS）和实质性临床获益（SCB），通常用于定义有意义的临床改善。然而，这些方法采用的是统一的分界点，不能解释个人的基准分数。最大可能改善（MPI）通过考虑功能的最大潜在增益或疼痛的减少，提供了一种针对患者的方法。在Latarjet手术后，MPI百分比（%MPI）与术后患者高满意度相关的比例尚未确定。本研究的目的是：(1)建立预测美国肩肘外科医生（ASES）评分患者高满意度的%MPI阈值，以及患者报告的结果测量信息系统（PROMIS）上肢功能（PUE）、疼痛干扰（P-Interference）和疼痛强度（P-Intensity）域；(2)确定与达到这些as和PUE阈值相关的患者水平因素。方法：回顾性分析81例接受Latarjet手术的患者，随访至少1年。记录术前和术后的ASES、PUE、P-Interference和P-Intensity评分，以及术后患者的满意度。进行受试者工作特征曲线分析，以确定4个评分中每个评分的百分比MPI阈值，该阈值最能预测术后至少1年的高满意度。顺序进行单因素和多因素logistic回归分析，以确定与达到asa和PUE阈值相关的患者因素。结果：在81例符合纳入标准的患者中，与高满意度相关的%MPI阈值为：as为65%（曲线下面积[AUC]: 0.86）， PUE为29% (AUC: 0.84)， p -干扰为57% (AUC: 0.78)， p -强度为59% （AUC: 0.77）。较高的体重指数（比值比[OR]: 1.16, p = 0.048）和优势臂手术（比值比[OR]: 3.87, p = 0.024）与较高的达到asa阈值的几率相关。术前复发性脱位（OR: 0.20, p = 0.022）与达到PUE阈值的几率较低相关。结论：Latarjet手术后最大可能改善百分比（%MPI）提供了临床成功的个性化衡量标准，并解释了基线变异性并减轻了天花板效应。Latarjet手术后患者满意度高的相关阈值为：as≥65%，PUE≥29%，p -干扰≥57%，p -强度≥59%。

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引用次数: 0

Deep learning for automated 3D assessment of rotator cuff muscle atrophy and fat infiltration prior to total shoulder arthroplasty 深度学习用于全肩关节置换术前肩袖肌萎缩和脂肪浸润的自动三维评估。

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery

Pub Date : 2026-03-01 Epub Date: 2025-09-01 DOI: 10.1016/j.jse.2025.07.025

Jay M. Levin MD, MBA , Osman B. Satir PhD , Eoghan T. Hurley MD, PhD , Christopher A. Colasanti MD , Fabio Becce MD , Alexandre Terrier PhD , Pezhman Eghbali PhD , Patrick Goetti MD , Christopher Klifto MD , Oke Anakwenze MD, MBA , Mark A. Frankle MD , Surena Namdari MD , Philippe Büchler PhD

Background

Rotator cuff muscle pathology affects outcomes following total shoulder arthroplasty, yet current assessment methods lack reliability in quantifying muscle atrophy and fat infiltration. We developed a deep learning-based model for automated segmentation of rotator cuff muscles on computed tomography (CT) and propose a T-score classification of volumetric muscle atrophy. We further characterized distinct atrophy phenotypes, 3D fat infiltration percentage (3DFI%), and anterior-posterior (AP) balance, which were compared between healthy controls, anatomic total shoulder arthroplasty (aTSA), and reverse total shoulder arthroplasty (rTSA) patients.

Methods

A total of 952 shoulder CT scans were included (762 controls, 103 undergoing aTSA for glenohumeral osteoarthritis, and 87 undergoing rTSA for cuff tear arthropathy. A deep learning model was developed to allow automated segmentation of supraspinatus (SS), subscapularis (SC), infraspinatus (IS), and teres minor (TM). Muscle volumes were normalized to scapula volume, and control muscle volumes were referenced to calculate T-scores for each muscle. T-scores were classified as no atrophy (>−1.0), moderate atrophy (−1 to −2.5), and severe atrophy (<−2.5). 3DFI% was quantified as the proportion of fat within each muscle using Hounsfield unit thresholds. The T-scores, 3DFI%, and AP balance were compared between the three cohorts.

Results

The aTSA cohort had significantly greater atrophy in all muscles compared to control (P < .001), whereas the rTSA cohort had significantly greater atrophy in SS, SC, and IS than aTSA (P < .001). In the aTSA cohort, the most common phenotype was SS_severe/SC_moderate/IS + TM_moderate, while in the rTSA cohort it was SS_severe/SC_moderate/IS + TM_severe. The aTSA group had significantly higher 3DFI% compared to controls for all muscles (P < .001), while the rTSA cohort had significantly higher 3DFI% than aTSA and control cohorts for all muscles (P < .001). Additionally, the aTSA cohort had a significantly lower AP muscle volume ratio (1.06 vs. 1.14, P < .001), whereas the rTSA group had a significantly higher AP muscle volume ratio than the control cohort (1.31 vs. 1.14, P < .001).

Discussion

Our study demonstrates successful development of a deep learning model for automated volumetric assessment of rotator cuff muscle atrophy, 3DFI% and AP balance on shoulder CT scans. We found that aTSA patients had significantly greater muscle atrophy and 3DFI% than controls, while the rTSA patients had the most severe muscle atrophy and 3DFI%. Additionally, distinct phenotypes of muscle atrophy and AP muscle balance exist in aTSA and rTSA that warrant further investigation with regards to shoulder arthroplasty outcomes.

简介：肩袖肌肉病理影响全肩关节置换术后的预后，但目前的评估方法在量化肌肉萎缩和脂肪浸润方面缺乏可靠性。我们开发了一种基于深度学习的模型，用于在计算机断层扫描（CT）上自动分割肩袖肌肉，并提出了体积性肌肉萎缩的t评分分类。我们进一步表征了不同的萎缩表型、3D脂肪浸润百分比（3DFI%）和前后（AP）平衡，并比较了健康对照、解剖性全肩关节置换术（aTSA）和反向全肩关节置换术（rTSA）患者。方法：952例肩部CT扫描（762例对照，103例肩关节骨性关节炎行aTSA， 87例袖带撕裂性关节病行rTSA）。开发了一个深度学习模型来实现冈上肌（SS）、肩胛下肌（SC）、冈下肌（IS）和小圆肌（TM）的自动分割。肌肉体积归一化为肩胛骨体积，参照对照肌肉体积计算每块肌肉的t分数。t评分分为无萎缩（>-1.0），中度萎缩（-1至-2.5）和严重萎缩（结果：与对照组相比，aTSA队列的所有肌肉萎缩（psevere/SCmoderate/IS+TMmoderate）明显更大，而rTSA队列为SSsevere/SCmoderate/IS+TMsevere）。与对照组相比，aTSA组所有肌肉的3DFI%都明显更高(讨论：我们的研究成功开发了一种深度学习模型，用于自动评估肩袖肌萎缩、3DFI%和肩部CT扫描的AP平衡。我们发现aTSA患者的肌肉萎缩和3DFI%明显高于对照组，而rTSA患者的肌肉萎缩和3DFI%最严重。此外，aTSA和rTSA中存在不同的肌肉萎缩和AP肌肉平衡表型，这需要进一步研究肩关节置换术的结果。

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引用次数: 0

Distance traveled is not associated with rate of same-day discharge after primary total shoulder arthroplasty 行走距离与初次全肩关节置换术后当日出院率无关。

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery

Pub Date : 2026-03-01 Epub Date: 2025-08-25 DOI: 10.1016/j.jse.2025.07.014

Lucas R. Haase MD , Brandon T. Fisher MD , Justin T. Deslaurier MD , Ryan S. McNassor MD , Kaleb R. Howard MD , Elijah C. Auch MD , Brett P. Wiater MD , Alexander Martusiewicz MD , J. Michael Wiater MD

Background

Cost conservation and value are major components of orthopedic surgery and health economics. One measure frequently used by surgeons to mitigate cost is the utilization of same-day discharge (SDD) after total shoulder arthroplasty (TSA). With SDD, we must also identify patient factors that support its safety and suitability. The purpose of this study was to investigate if patient travel distance is associated with safe SDD. Secondarily, we aimed to identify other patient factors associated with safe SDD.

Methods

This retrospective review included all patients undergoing primary anatomic or reverse TSA by a single surgeon at a single institution between January 2021 and June 2024 in a hospital setting. Patient demographic information, medical comorbidities, surgical factors, and distance in miles to the hospital were collected. Patients were placed into 2 groups: those discharged the same day as surgery and those requiring ≥ 1 night hospital stay. Outcomes collected included implant complications, 90-day emergency department utilization, and 90-day readmissions.

Results

691 patients met inclusion criteria. Of these, 358 were SDD, while 333 stayed ≥ 1 night. There was no association between distance traveled and SDD. Patients who were admitted were older (73.12 vs. 69.14; P < .001), more frequently women (63.1% vs. 44.7%; P < .001), less likely to be independent ambulators (70.3 % vs. 82.4%; P < .001), and more likely to live alone (24.6% vs. 11.7%; P < .001). Patients admitted for ≥ 1 night stay were also more likely to have a higher American Society of Anesthesiologists (ASA) score, have history of diabetes mellitus, hypertension, coronary artery disease, and chronic kidney disease. Of all significant factors, age, female gender, level of assistance at home, and ASA III remained significantly associated with hospital admission on multivariate testing. There was no difference between the 2 groups regarding implant complications, 90-day emergency department utilization, or 90-day readmissions.

Conclusion

The decision for SDD after TSA is multifactorial, but is not associated with the distance traveled by the patient to the hospital. Increased age, female gender, use of cane for ambulation, and ASA III are independently associated with the need for hospital admission after TSA. Living with a spouse is independently associated with SDD.

成本节约和价值是骨科外科和卫生经济学的主要组成部分。外科医生经常使用的一种措施是全肩关节置换术（TSA）后当天出院（SDD）。对于SDD，我们还必须确定支持其安全性和适用性的患者因素。本研究的目的是调查患者出行距离是否与安全SDD相关。其次，我们旨在确定与安全SDD相关的其他患者因素。方法：本回顾性研究纳入了2021年1月至2024年6月在同一医院由同一位外科医生进行初级解剖或反向全肩关节置换术的所有患者。收集了患者的人口统计信息、医疗合并症、手术因素和到医院的距离。将患者分为两组：手术当天出院的患者和住院≥1晚的患者。收集的结果包括种植体并发症、90天急诊科使用率和90天再入院率。结果：691例患者符合纳入标准。其中358例为SDD， 333例住宿≥1晚。旅行距离和SDD之间没有关联。入院的患者年龄较大（73.12 v 69.14; p < 0.001），女性较多（63.1% v 44.7%; p < 0.001），使用独立行走器的可能性较小（70.3% v 82.4%; p < 0.001），独居的可能性较大（24.6% v 11.7%; p < 0.001）。住院≥1晚的患者ASA评分较高，有糖尿病、高血压、冠状动脉疾病和慢性肾脏疾病病史的患者也较多。在所有重要因素中，年龄、女性性别、家庭援助水平和ASA III在多变量测试中仍与住院率显著相关。两组在种植体并发症、90天ED使用率和90天再入院方面没有差异。结论：全肩关节置换术后SDD的决定是多因素的，但与患者到医院的路程无关。年龄增加、女性、使用手杖行走和ASA III与全肩关节置换术后住院需要独立相关。与配偶同住与同日离职独立相关。证据等级:三级;回顾性队列比较；预后研究。

{"title":"Distance traveled is not associated with rate of same-day discharge after primary total shoulder arthroplasty","authors":"Lucas R. Haase MD , Brandon T. Fisher MD , Justin T. Deslaurier MD , Ryan S. McNassor MD , Kaleb R. Howard MD , Elijah C. Auch MD , Brett P. Wiater MD , Alexander Martusiewicz MD , J. Michael Wiater MD","doi":"10.1016/j.jse.2025.07.014","DOIUrl":"10.1016/j.jse.2025.07.014","url":null,"abstract":"<div><h3>Background</h3><div>Cost conservation and value are major components of orthopedic surgery and health economics. One measure frequently used by surgeons to mitigate cost is the utilization of same-day discharge (SDD) after total shoulder arthroplasty (TSA). With SDD, we must also identify patient factors that support its safety and suitability. The purpose of this study was to investigate if patient travel distance is associated with safe SDD. Secondarily, we aimed to identify other patient factors associated with safe SDD.</div></div><div><h3>Methods</h3><div>This retrospective review included all patients undergoing primary anatomic or reverse TSA by a single surgeon at a single institution between January 2021 and June 2024 in a hospital setting. Patient demographic information, medical comorbidities, surgical factors, and distance in miles to the hospital were collected. Patients were placed into 2 groups: those discharged the same day as surgery and those requiring ≥ 1 night hospital stay. Outcomes collected included implant complications, 90-day emergency department utilization, and 90-day readmissions.</div></div><div><h3>Results</h3><div>691 patients met inclusion criteria. Of these, 358 were SDD, while 333 stayed ≥ 1 night. There was no association between distance traveled and SDD. Patients who were admitted were older (73.12 vs. 69.14; <em>P</em> < .001), more frequently women (63.1% vs. 44.7%; <em>P</em> < .001), less likely to be independent ambulators (70.3 % vs. 82.4%; <em>P</em> < .001), and more likely to live alone (24.6% vs. 11.7%; <em>P</em> < .001). Patients admitted for ≥ 1 night stay were also more likely to have a higher American Society of Anesthesiologists (ASA) score, have history of diabetes mellitus, hypertension, coronary artery disease, and chronic kidney disease. Of all significant factors, age, female gender, level of assistance at home, and ASA III remained significantly associated with hospital admission on multivariate testing. There was no difference between the 2 groups regarding implant complications, 90-day emergency department utilization, or 90-day readmissions.</div></div><div><h3>Conclusion</h3><div>The decision for SDD after TSA is multifactorial, but is not associated with the distance traveled by the patient to the hospital. Increased age, female gender, use of cane for ambulation, and ASA III are independently associated with the need for hospital admission after TSA. Living with a spouse is independently associated with SDD.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 892-898"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976659","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}

引用次数: 0

Association between central obesity and the risk of glenohumeral joint osteoarthritis: a prospective study 中心性肥胖与盂肱关节骨关节炎风险之间的关系：一项前瞻性研究。

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery

Pub Date : 2026-03-01 Epub Date: 2025-08-21 DOI: 10.1016/j.jse.2025.07.007

Qiang He MD , Jinning Zhang MMed , Zhentao Man PhD , Jianing Liu PhD , Wei Li PhD , Yong Sun PhD , Feng Xu PhD

Background

The relationship between obesity and glenohumeral joint osteoarthritis (GJO) has long been a subject of doubt. Although body mass index (BMI) has been recognized as a risk factor by guidelines, it fails to reflect fat distribution, which may limit its clinical application value. Waist-to-height ratio (WHtR), as an indicator of central obesity, has shown good predictive performance in metabolic-related diseases. However, its role in GJO remains unclear. This study aimed to investigate the relationship between central obesity and GJO through a prospective cohort study in the UK Biobank.

Methods

We conducted a prospective cohort study based on the UK Biobank, including 32,900 adults who participated in the baseline survey between 2006 and 2014 and had no history of GJO. The median follow-up time was 8.85 years (IQR: 7.15-10.75). Cox proportional hazards models were used to assess the association between WHtR levels at baseline and the incidence of new GJO at the end of follow-up. Interaction and sensitivity analyses were conducted in different BMI strata.

Results

A significant linear correlation was observed between WHtR levels at baseline and the incidence risk of GJO at the end of follow-up (P < .001). Compared with individuals with normal WHtR at baseline, those with central obesity had a 1.52-fold increased risk of GJO (AHRs = 1.52, 95% CI: 1.02-2.26, P = .039), independent of BMI. Further analysis revealed that this association was more significant in the secondary GJO population (AHR = 1.74, 95% CI: 1.10-2.76, P = .019). Additionally, in the population with normal BMI at baseline, individuals with WHtR ≥0.5 had a 1.94-fold increased risk of GJO (AHRs = 1.94, 95% CI: 1.01-3.72, P = .046), but no significant association was observed in the population with overweight or obese BMI at baseline (P = .492; 0.998). Subgroup analysis showed that individuals under 65 year old, females, those with insufficient physical activity, and those with lower occupational physical activity had a higher risk (P = .014; 0.046; 0.005; 0.007).

Conclusions

Central obesity is significantly associated with the risk of GJO, especially in the secondary GJO and normal BMI populations, suggesting that fat distribution should be included in the early screening and risk assessment system for GJO.

背景：肥胖与盂肱关节骨性关节炎（GJO）之间的关系长期以来一直受到质疑。虽然身体质量指数（BMI）已被指南认可为一个危险因素，但它不能反映脂肪分布，这可能会限制其临床应用价值。腰高比（WHtR）作为中心性肥胖的指标，在代谢相关疾病中表现出良好的预测效果。然而，它在GJO中的作用仍不清楚。本研究旨在通过英国生物银行（UKB）的前瞻性队列研究调查中心性肥胖与GJO之间的关系。方法：我们基于UK Biobank进行了一项前瞻性队列研究，包括32,900名在2006年至2014年期间参加基线调查的无GJO病史的成年人。中位随访时间为8.85年（IQR: 7.15 ~ 10.75）。采用Cox比例风险模型评估基线WHtR水平与随访结束时新发GJO发生率之间的关系。在不同BMI层进行交互作用和敏感性分析。结果：基线时的WHtR水平与随访结束时GJO发生率之间存在显著的线性相关（P < 0.001）。与基线WHtR正常的个体相比，中心性肥胖的GJO风险增加1.52倍（ahr = 1.52, 95% CI: 1.02-2.26, P = 0.039），与BMI无关。进一步分析显示，这种关联在继发GJO人群中更为显著（AHR = 1.74, 95% CI: 1.10-2.76, P = 0.019）。此外，在基线BMI正常的人群中，WHtR≥0.5的个体发生GJO的风险增加1.94倍（ahr = 1.94, 95% CI: 1.01-3.72, P = 0.046），但在基线BMI超重或肥胖人群中未观察到显著相关性（P = 0.492;0.998）。亚组分析显示，65岁以下、女性、体力活动不足者和职业体力活动较低者的风险较高（P = 0.014、0.046、0.005、0.007）。结论：中心性肥胖与GJO风险显著相关，尤其是继发性GJO和BMI正常人群，提示应将脂肪分布纳入GJO早期筛查和风险评估体系。

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引用次数: 0

Comparison of locking plate alone and locking plate combined with 3D printed polymethylmethacrylate augmentation in treating proximal humerus fractures in elderly 单独锁定钢板与锁定钢板联合3D打印聚甲基丙烯酸甲酯增强治疗老年人肱骨近端骨折的比较。

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery

Pub Date : 2026-03-01 Epub Date: 2025-08-25 DOI: 10.1016/j.jse.2025.08.001

Xiang-Yu Ma MD, PhD , Tian-Yu Han MD, PhD , Da-Peng Zhou MD, PhD , Dong Cui MD, PhD , Bing Liu MD, PhD , Yong Zhao MD, PhD , Hai-Peng Xue MD, PhD , Hai-Long Yu MD, PhD , Hong Yuan MD, PhD

Background

Locking plates are widely used in open reduction internal fixation for proximal humeral fracture (PHF). However, the optimal surgical treatment of unstable, displaced PHF in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes of surgical treatment of PHF in the elderly with locking plate (LP) alone and LP combined with 3D printed polymethylmethacrylate (PMMA) prosthesis augmentation (LP-PA).

Methods

From May 2015 to April 2021, a total of 97 patients aged ≥60 years with acute unstable PHF who underwent osteosynthesis with either LP (46 patients) or LP-PA (51 patients) were retrospectively analyzed. For the LP-PA group, a customized proximal humeral prosthesis made of PMMA cement was intra-operatively fabricated by a three-dimensional (3D) printed prototype mold for the humeral medial support. Radiological outcomes were analyzed by measuring the value of neck-shaft angle and humeral head height. The clinical outcomes were evaluated using Constant-Murley Score, Disabilities of the Arm Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score, and the shoulder range of motion. Pain was measured using a visual analog scale.

Results

At the 1-year follow-up, all fractures healed radiologically and clinically. The mean changes of neck-shaft angle and humeral head height over the follow-up period were markedly smaller in the LP-PA group (3.8 ± 0.9° and 1.7 ± 0.3 mm) than those in the LP group (9.7 ± 2.1° and 3.2 ± 0.6 mm, both P < .0001). The LP-PA group also presented lower DASH score (17.1 ± 3.6), higher ASES score (89.5 ± 11.2) and better range of motion in forward elevation (142 ± 26°) and external rotation (59 ± 11°) compared to the LP group (28.9 ± 4.8 for DASH score, P < .0001; 82.3 ± 9.0 for ASES score, P < .001; 129 ± 21° for forward elevation, P = .008; and 52 ± 9° for external rotation, P = .001). There was no significant difference in overall complication rate between the 2 groups (P = .172), although the complication rate of screw perforation was higher in the LP-PA group (P = .025).

Conclusions

For PHF in elderly patients, the combination of LP fixation and PMMA prosthesis augmentation effectively improved humeral head support and reduction maintenance, providing satisfactory outcomes both radiologically and clinically. This technique also reduced the incidence of screw perforation associated with plate fixation alone, making it a reasonable option to ensure satisfactory clinical outcomes.

背景：锁定钢板广泛应用于肱骨近端骨折（PHF）的切开复位内固定（ORIF）。然而，老年患者不稳定、移位的PHF的最佳手术治疗仍存在争议。本研究旨在比较单独使用锁定钢板（LP）和锁定钢板联合3D打印聚甲基丙烯酸甲酯（PMMA）假体增强（LP- pa）手术治疗老年人PHF的放射学和临床结果。方法：回顾性分析2015年5月至2021年4月97例≥60岁急性不稳定型PHF患者行LP（46例）或LP- pa（51例）植骨术。对于LP-PA组，术中使用三维（3D）打印原型模具制作定制的PMMA水泥肱骨近端假体，用于肱骨内侧支撑。通过测量颈轴角（NSA）和肱骨头高度（HHH）来分析放射学结果。临床结果采用Constant-Murley评分（CMS）、臂肩和手残疾（DASH）评分、American Shoulder and肘部外科医生（ASES）评分和肩部活动范围（ROM）进行评估。疼痛采用视觉模拟量表（VAS）测量。结果：随访1年，所有骨折影像学及临床均愈合。LP- pa组随访期间NSA和HHH的平均变化（3.8±0.9°和1.7±0.3 mm）明显小于LP组（9.7±2.1°和3.2±0.6 mm， P均< 0.0001）。与LP组相比，LP- pa组DASH评分（17.1±3.6）低，ASES评分（89.5±11.2）高，前仰（142±26°）和外旋（59±11°）ROM更好（DASH评分28.9±4.8,P < 0.0001； ASES评分82.3±9.0,P < 0.001；前仰129±21°，P = 0.008；外旋52±9°，P = 0.001）。两组总并发症发生率差异无统计学意义，但LP-PA组螺钉穿孔并发症发生率较高（P = 0.172）。结论：对于老年PHF患者，LP固定联合PMMA假体增强有效地改善了肱骨头支撑和复位维持，影像学和临床结果均令人满意。该技术还减少了单独钢板固定时螺钉穿孔的发生率，使其成为确保满意临床结果的合理选择。

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引用次数: 0

Letter to the editor regarding Ritter et al: “Machine learning models can define clinically relevant bone density subgroups based on patient-specific calibrated computed tomography scans in patients undergoing reverse shoulder arthroplasty” 致编辑关于“机器学习模型可以根据接受反向肩关节置换术的患者的特定校准计算机断层扫描来定义临床相关的骨密度亚组”的信。

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery

Pub Date : 2026-03-01 Epub Date: 2025-09-10 DOI: 10.1016/j.jse.2025.07.035

Nam Jun Baek MD, Seorin Park MD

引用次数: 0

Development and validation of the APEX-HBD SCORe: a multivariable prediction model for postoperative complications in patients undergoing shoulder arthroplasty APEX-HBD评分的开发和验证：肩关节置换术患者术后并发症的多变量预测模型

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery

Pub Date : 2026-03-01 Epub Date: 2025-08-14 DOI: 10.1016/j.jse.2025.06.029

Majd Mzeihem MD , Wedam Nyaaba PhD , James Oosten MD , Mark H. Gonzalez MD, PhD , Jason Koh MD , Benjamin A. Goldberg MD , Farid Amirouche PhD

Background

The incidence of total shoulder arthroplasty (TSA) has risen significantly, driven by expanded indications. This study aims to derive and validate a model for classifying patients based on the risk of short-term complications using logistic regression (LR) and other machine learning (ML) techniques.

Methods

We analyzed de-identified data from the American College of Surgeons' NSQIP database (2005–2022), identifying 39,028 patients who underwent SA using CPT codes. The dataset was split into derivation (60%) and validation (40%) cohorts. We constructed baseline classifiers for complications using backward stepwise multivariate LR and developed the APEX-HBD SCORe, a point-based system to stratify patients into low (<5%), moderate (5–11%), and high-risk (≥19%) categories. To improve accuracy, we also developed ML models, including Gradient Boosting, AdaBoost, Random Forest, and Extra Randomized Trees, using the same predictors identified in the LR model.

Results

The derivation cohort (23,417 patients) reported 1,476 (6.3%) patients with complications. LR identified 11 predictors, including albumin levels, hematocrit, ASA classification, preoperative transfusion, and other relevant factors. LR achieved area under the curves of 72%, 75%, 77%, and 63% for any, medical, serious medical, and surgical complications, respectively, in the derivation cohort, and 70%, 75%, 73%, and 58% in the validation cohort—outperforming the 5-item modified frailty index. Gradient Boosting performed best among ML models, with area under the curves of 73%, 82%, 76%, and 67%. APEX-HBD SCORe risk stratification revealed a progressive increase in complication rates across categories, confirmed in the validation cohort.

Conclusion

This 16-year analysis introduces the APEX-HBD SCORe, a validated ML-augmented tool predicting 30-day complications using 11 patient factors. It aids in patient stratification, counseling, preoperative planning, and tailored postoperative management.

背景：由于适应证的扩大，肩关节置换术（SA）的发生率显著上升。本研究旨在利用逻辑回归（LR）和其他机器学习（ML）技术，推导并验证一个基于短期并发症风险对患者进行分类的模型。方法：我们分析了来自美国外科医师学会NSQIP数据库（2005-2022）的去识别数据，确定了39028例使用CPT编码接受SA的患者。数据集被分为衍生（60%）和验证（40%）队列。我们使用后向逐步多变量LR构建了并发症的基线分类器，并开发了APEX-HBD SCORe，这是一个基于点的系统，将患者分为低(结果：衍生队列（23,417例患者）报告了1,476例（6.3%）并发症患者。LR确定了11个预测因素，包括白蛋白水平、红细胞压积、ASA分类、术前输血和其他相关因素。在衍生队列中，对于任何、医疗、严重医疗和手术并发症，LR的auc分别为72%、75%、77%和63%，在验证队列中为70%、75%、73%和58%，优于5项修正脆弱指数（MFI_5）。梯度增强在ML模型中表现最好，auc分别为73%、82%、76%和67%。APEX-HBD SCORe风险分层显示，不同类别的并发症发生率逐渐增加，这在验证队列中得到证实。结论：这项为期16年的分析引入了APEX-HBD SCORe，这是一种经过验证的ml增强工具，可使用11个患者因素预测30天的并发症。它有助于患者分层、咨询、术前计划和量身定制的术后管理。证据水平：基础科学研究；利用机器学习开发和验证预测模型。

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引用次数: 0

Is acromial morphology different in patients with eccentric glenohumeral osteoarthritis? 偏心型盂肱骨关节炎患者的肩峰形态不同吗？

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery

Pub Date : 2026-03-01 Epub Date: 2025-08-25 DOI: 10.1016/j.jse.2025.07.016

Lindsey G. Kahan MD , Rebekah L. Lawrence PT, PhD , Jay D. Keener MD , Alexander Aleem MD , Benjamin M. Zmistowski MD

Background

Acromial morphology has been implicated as a potential contributor to eccentric glenohumeral osteoarthritis (GHOA), leading to the development of novel procedures, including scapular spine corrective osteotomies. However, there remains a substantial gap in knowledge on the relationship between acromial morphology and eccentric GHOA. This study utilized a comprehensive three-dimensional semiautomated analysis of acromial morphology to assess its association with eccentric GHOA patterns.

Methods

A retrospective chart review was conducted to identify symptomatic patients with GHOA undergoing evaluation for total shoulder arthroplasty. Patients were classified as having eccentric vs. concentric GHOA based on the Walch criteria. A sample of healthy controls was also included from a previous investigation. Three-dimensional bone models of the scapula were reconstructed from computed tomography scans, and scapular morphology was calculated using custom software to measure sagittal acromial tilt, coronal acromial tilt, axial acromial tilt, lateral acromial ratio, glenoid inclination, glenoid version, and acromial coverage relative to the scapular body. These morphology variables were compared between groups using analysis of covariance, adjusting for sex.

Results

Ninety-eight patients with GHOA (mean age: 64.7 years; 26.5% female; Walch A: 26, Walch B: 72) and 40 healthy controls (mean age: 55.2 years; 65% female) were included. Patients with Walch B glenoids were 15.0° ± 1.4° more retroverted than patients with Walch A glenoids (P < .01) and 14.9° ± 1.6° more retroverted than healthy controls (P < .01). Patients with Walch B (−8.5° ± 0.9°) had more inferiorly inclined glenoids than those with Walch A (−4.1° ± 1.5°), and both groups had more inferior inclination than healthy controls (1.3° ± 1.2°; P ≤ .03). Patients with GHOA exhibited less posterior and overall acromial coverage than healthy controls (P < .01). Patients with Walch B glenoids had a 6.9° ± 1.6° higher sagittal acromial tilt compared to healthy controls (P < .01), and no differences were found between groups in coronal tilt or axial tilt. Patients with Walch B glenoids had less lateralized acromions than those with Walch A glenoids and healthy controls (P < .01).

Conclusions

There is significant variability in acromial morphology among patients with GHOA compared to healthy controls. While the effect sizes are small, patients with Walch B glenoids had flatter acromion relative to healthy controls and less lateralized acromion relative to both healthy controls and Walch A glenoids. Further research is needed to understand the causative relationship between acromial morphology and the development of eccentric GHOA.

背景：肩峰形态被认为是偏心型盂肱骨关节炎（GHOA）的潜在因素，导致了包括肩胛骨矫正截骨术在内的新手术的发展。然而，关于肩峰形态与偏心性高骨关节炎之间的关系，目前还存在很大的知识空白。本研究利用全面的三维（3D）半自动化分析肩峰形态来评估其与偏心性高骨关节炎模式的关系。方法：对有症状的接受全肩关节置换术评估的GHOA患者进行回顾性分析。根据Walch标准将患者分为偏心型和同心型GHOA。从以前的调查中也纳入了健康对照样本。通过CT扫描重建肩胛骨三维骨模型，使用定制软件计算肩胛骨形态，测量：矢状峰倾斜、冠状峰倾斜、轴向峰倾斜、侧峰比、肩胛倾斜、肩胛形态、肩胛骨相对于肩胛骨体的覆盖率。使用ANCOVA对这些形态学变量进行性别调整后的组间比较。结果：纳入98例GHOA患者（平均年龄64.7岁，女性26.5%；Walch A: 26岁，Walch B: 72岁）和40例健康对照（平均年龄55.2岁，女性65%）。Walch B型肩胛盂比Walch A型肩胛盂内倾多15.0°±1.4°(结论：与健康对照相比，GHOA患者肩胛形态存在显著差异。虽然效应量很小，但与健康对照组相比，患有Walch B型肩胛盂的患者肩峰更平坦，与健康对照组和Walch A型肩胛盂相比，肩峰偏侧程度更低。肩峰形态与偏心性高骨关节炎发生的因果关系有待进一步研究。证据等级:三级;横断面队列比较；预后研究。

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引用次数: 0