Pub Date : 2024-08-10DOI: 10.1177/17585732241268712
Alexander N. Berk, Allison J Rao, Kyle K Obana, A. M. Ifarraguerri, David P. Trofa, Patrick M. Connor, Shadley C. Schiffern, Nady Hamid, Bryan M. Saltzman
Outcomes of reverse shoulder arthroplasty (RSA) in patients with prior rotator cuff repair (RCR) remain inconsistent. The purpose of this study, therefore, was to systematically review the current outcomes literature on RSA in patients with prior RCR and to compare the results with controls without prior RCR. A systematic review of the literature was performed, and outcome studies reporting on functional and clinical outcomes were included. A total of 11 studies encompassing 2879 shoulders were included. Improvements in postoperative patient-reported outcomes (PROs) from the baseline were higher in controls including the American Shoulder and Elbow Surgeons score (47.0 vs 39.5), Simple Shoulder Test (6.0 vs 4.9), Constant score (32.6 vs 26.4), and Visual Analog Scale for pain (−5.6 vs −4.9). Improvement in range of motion was greater in the control group, including external rotation (17° vs 11°), anterior elevation (56° vs 43°), and abduction (52° vs 43°). The overall complication rate (8% vs 5%) and revision rate (3% vs 1%) were higher in the RCR group. Differences in postoperative PROs and improvement from the baseline demonstrate a trend toward lower outcomes in patients with prior RCR but may be below the minimal clinically import difference. IV; systematic review
曾接受过肩袖修复术（RCR）的患者接受反向肩关节置换术（RSA）的结果仍不一致。因此，本研究的目的是系统回顾目前关于曾接受过肩袖修补术（RCR）的患者接受反向肩关节置换术（RSA）的结果文献，并将结果与未接受过肩袖修补术的对照组进行比较。本研究对相关文献进行了系统性回顾，并纳入了报告功能和临床结果的研究。共纳入了 11 项研究，涉及 2879 个肩关节。对照组患者的术后患者报告结果（PROs）较基线有更大改善，包括美国肩肘外科医生评分（47.0 vs 39.5）、简单肩关节测试（6.0 vs 4.9）、Constant评分（32.6 vs 26.4）和疼痛视觉模拟量表（-5.6 vs -4.9）。对照组的活动范围改善幅度更大，包括外旋（17° vs 11°）、前抬（56° vs 43°）和外展（52° vs 43°）。RCR 组的总体并发症发生率（8% 对 5%）和翻修率（3% 对 1%）更高。术后 PROs 的差异以及与基线相比的改善情况表明，曾接受过 RCR 的患者的预后有降低的趋势，但可能低于最小临床意义差异。IV；系统综述
{"title":"Is the impact of previous rotator cuff repair on the outcome of reverse shoulder arthroplasty clinically relevant? A systematic review of 2879 shoulders","authors":"Alexander N. Berk, Allison J Rao, Kyle K Obana, A. M. Ifarraguerri, David P. Trofa, Patrick M. Connor, Shadley C. Schiffern, Nady Hamid, Bryan M. Saltzman","doi":"10.1177/17585732241268712","DOIUrl":"https://doi.org/10.1177/17585732241268712","url":null,"abstract":"Outcomes of reverse shoulder arthroplasty (RSA) in patients with prior rotator cuff repair (RCR) remain inconsistent. The purpose of this study, therefore, was to systematically review the current outcomes literature on RSA in patients with prior RCR and to compare the results with controls without prior RCR. A systematic review of the literature was performed, and outcome studies reporting on functional and clinical outcomes were included. A total of 11 studies encompassing 2879 shoulders were included. Improvements in postoperative patient-reported outcomes (PROs) from the baseline were higher in controls including the American Shoulder and Elbow Surgeons score (47.0 vs 39.5), Simple Shoulder Test (6.0 vs 4.9), Constant score (32.6 vs 26.4), and Visual Analog Scale for pain (−5.6 vs −4.9). Improvement in range of motion was greater in the control group, including external rotation (17° vs 11°), anterior elevation (56° vs 43°), and abduction (52° vs 43°). The overall complication rate (8% vs 5%) and revision rate (3% vs 1%) were higher in the RCR group. Differences in postoperative PROs and improvement from the baseline demonstrate a trend toward lower outcomes in patients with prior RCR but may be below the minimal clinically import difference. IV; systematic review","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141920894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1177/17585732241268904
AI Eyre-Brook, P. Kankanalu, L. Majkowski, N. Zreik, V. Jones, DS Thyagarajan, AA Ali, SJ Booker
Unstable and nonreconstructable radial head fractures require radial head arthroplasty (RHA) to restore stability. Multiple implant designs are available with varying survival rates (76 to 97%). There is concern that loosening of the press-fit stems leads to implant failure. We review our outcomes using the Acumed press-fit prosthesis for trauma. Between February 2008 and November 2020, all primary RHA for trauma from a single-centre were reviewed. Primary outcome was implant survivorship. Secondary outcome were clinical, radiographic and patient related outcome measures. In total, 96 cases were included. Seven revisions were recorded, all within 24-months of implantation. Kaplan–Meier estimated 10-year survival was 92.1% (95% confidence interval (CI) 84.0–96.1%). Median follow-up time was 5.7 years (Interquartile range (IQR) 3.2–8.5 years). Median Oxford Elbow Score was 43 (IQR 29–46) for and median Mayo Elbow Performance Score was 90 (IQR 72–100). 72% were able to fully-return to pre-injury activities. Radiographic analysis identified osteolysis around radial neck (48%), loosening (32%), valgus stem position (20%), heterotopic ossification (16%) and capitellar erosion (15%). No radiological findings were associated with long-term poor clinical outcomes. Our study demonstrates an excellent survival of press-fit RHA of 92.1% at 10-years. No radiographic features on follow-up were associated with poorer patient recorded outcome measures.
{"title":"Outcomes of press-fit radial head arthroplasty in unconstructable radial head fractures with associated elbow injuries: An average 5-year follow up","authors":"AI Eyre-Brook, P. Kankanalu, L. Majkowski, N. Zreik, V. Jones, DS Thyagarajan, AA Ali, SJ Booker","doi":"10.1177/17585732241268904","DOIUrl":"https://doi.org/10.1177/17585732241268904","url":null,"abstract":"Unstable and nonreconstructable radial head fractures require radial head arthroplasty (RHA) to restore stability. Multiple implant designs are available with varying survival rates (76 to 97%). There is concern that loosening of the press-fit stems leads to implant failure. We review our outcomes using the Acumed press-fit prosthesis for trauma. Between February 2008 and November 2020, all primary RHA for trauma from a single-centre were reviewed. Primary outcome was implant survivorship. Secondary outcome were clinical, radiographic and patient related outcome measures. In total, 96 cases were included. Seven revisions were recorded, all within 24-months of implantation. Kaplan–Meier estimated 10-year survival was 92.1% (95% confidence interval (CI) 84.0–96.1%). Median follow-up time was 5.7 years (Interquartile range (IQR) 3.2–8.5 years). Median Oxford Elbow Score was 43 (IQR 29–46) for and median Mayo Elbow Performance Score was 90 (IQR 72–100). 72% were able to fully-return to pre-injury activities. Radiographic analysis identified osteolysis around radial neck (48%), loosening (32%), valgus stem position (20%), heterotopic ossification (16%) and capitellar erosion (15%). No radiological findings were associated with long-term poor clinical outcomes. Our study demonstrates an excellent survival of press-fit RHA of 92.1% at 10-years. No radiographic features on follow-up were associated with poorer patient recorded outcome measures.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141926331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There has been an emphasis on racial disparities in orthopedic surgery. Recently, literature suggested Black and Hispanic patients at increased risk for adverse outcomes after Shoulder Arthroplasty (SA), but data regarding it is sparse and inconclusive. Therefore, we aim to conduct a meta-analysis to assess the role of racial disparity in causing adverse outcomes after SA. Following PRISMA guidelines, electronic databases PubMed, Scopus, Cochrane, and Google Scholar were queried. Studies meeting inclusion criteria were included. Results were analyzed by pooling Odds ratios along 95% Confidence interval, using random-effects model on RevMan 5.3. A total of 14 selected studies evaluated 1,781,783 patients. We found Black patients at higher risk of post-SA complications than White patients (OR 1.32(95% CI 1.25–1.39; p < 0.00001; I2 = 0%). No significant risk in Hispanics compared to white patients (OR 0.94(95% CI 0.81–1.09); p = 0.41; I2 = 65%). Compared to whites, black patients were at higher risk of an extended length of stay, postoperative blood transfusion, sepsis, venous thromboembolism, and non-home discharge. Compared to white patients, Hispanics were at higher risk for postoperative blood transfusion. Whites showed increased risk for readmission. Following SA, Black patients were likely to develop complications compared to White patients but no significant risk in Hispanics compared to Whites.
骨科手术中的种族差异问题一直备受关注。最近有文献表明，黑人和西班牙裔患者在肩关节置换术（SA）后出现不良后果的风险增加，但相关数据稀少且不确定。因此，我们旨在进行一项荟萃分析，以评估种族差异在肩关节置换术后不良后果中的作用。根据 PRISMA 指南，我们查询了 PubMed、Scopus、Cochrane 和 Google Scholar 等电子数据库。符合纳入标准的研究均被纳入。使用 RevMan 5.3 的随机效应模型对结果进行了汇总分析，并得出了 95% 的置信区间。共有 14 项入选研究对 1,781,783 名患者进行了评估。我们发现，黑人患者比白人患者更容易出现手术后并发症（OR 1.32(95% CI 1.25-1.39; p < 0.00001; I2 = 0%）。西班牙裔患者与白人患者相比无明显风险（OR 0.94(95% CI 0.81-1.09); p = 0.41; I2 = 65%）。与白人相比，黑人患者住院时间延长、术后输血、脓毒症、静脉血栓栓塞和非居家出院的风险更高。与白人患者相比，西班牙裔患者术后输血的风险更高。白人再次入院的风险更高。与白人患者相比，黑人患者术后更容易出现并发症，但与白人相比，西班牙裔患者术后出现并发症的风险并不明显。
{"title":"Racial disparity in postoperative complications following shoulder arthroplasty (SA): A systematic review and meta-analysis","authors":"Ramish Sumbal, Uooja Devi, Saad Ashraf, Anusha Sumbal","doi":"10.1177/17585732241264023","DOIUrl":"https://doi.org/10.1177/17585732241264023","url":null,"abstract":"There has been an emphasis on racial disparities in orthopedic surgery. Recently, literature suggested Black and Hispanic patients at increased risk for adverse outcomes after Shoulder Arthroplasty (SA), but data regarding it is sparse and inconclusive. Therefore, we aim to conduct a meta-analysis to assess the role of racial disparity in causing adverse outcomes after SA. Following PRISMA guidelines, electronic databases PubMed, Scopus, Cochrane, and Google Scholar were queried. Studies meeting inclusion criteria were included. Results were analyzed by pooling Odds ratios along 95% Confidence interval, using random-effects model on RevMan 5.3. A total of 14 selected studies evaluated 1,781,783 patients. We found Black patients at higher risk of post-SA complications than White patients (OR 1.32(95% CI 1.25–1.39; p < 0.00001; I2 = 0%). No significant risk in Hispanics compared to white patients (OR 0.94(95% CI 0.81–1.09); p = 0.41; I2 = 65%). Compared to whites, black patients were at higher risk of an extended length of stay, postoperative blood transfusion, sepsis, venous thromboembolism, and non-home discharge. Compared to white patients, Hispanics were at higher risk for postoperative blood transfusion. Whites showed increased risk for readmission. Following SA, Black patients were likely to develop complications compared to White patients but no significant risk in Hispanics compared to Whites.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141800957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-25DOI: 10.1177/17585732241262524
C. Pereira, M. Carrapatoso, L. Barros, R. Claro
The implications of notching in reverse shoulder arthroplasty (RSA), and its relation with the rate of complications are still unclear. Our main aim was to retrospectively study the notching incidence in the three most used implants in our practice, considering their different neck-shaft angle (NSA) and determine its relation with implant failure, or other complications. We retrospectively reviewed medical and imaging records of 259 patients who underwent RSA in our hospital, including surgery reports, prosthesis designs and techniques. We assessed all radiographs taken during the follow up to evaluate notching incidence, progression and signs of failure. Notching occurred in 35% cases. The average time to notch development was 19 months. Implants with a lower NSA showed significantly lower incidence of notching when compared to other implants ( P < 0.001). In a multivariate analysis, the NSA proved to be an independent predictor for the occurrence of notching in this series. According to our results, higher NSA is an independent predictor of the occurrence of notching. There was significant increase in the notching rate with follow up. In the future, larger case series with longer follow-up are necessary to evaluate the relation between notching and radiological and clinical complications.
{"title":"Glenoid notching after reverse shoulder arthroplasty: The influence of different neck-shaft angles","authors":"C. Pereira, M. Carrapatoso, L. Barros, R. Claro","doi":"10.1177/17585732241262524","DOIUrl":"https://doi.org/10.1177/17585732241262524","url":null,"abstract":"The implications of notching in reverse shoulder arthroplasty (RSA), and its relation with the rate of complications are still unclear. Our main aim was to retrospectively study the notching incidence in the three most used implants in our practice, considering their different neck-shaft angle (NSA) and determine its relation with implant failure, or other complications. We retrospectively reviewed medical and imaging records of 259 patients who underwent RSA in our hospital, including surgery reports, prosthesis designs and techniques. We assessed all radiographs taken during the follow up to evaluate notching incidence, progression and signs of failure. Notching occurred in 35% cases. The average time to notch development was 19 months. Implants with a lower NSA showed significantly lower incidence of notching when compared to other implants ( P < 0.001). In a multivariate analysis, the NSA proved to be an independent predictor for the occurrence of notching in this series. According to our results, higher NSA is an independent predictor of the occurrence of notching. There was significant increase in the notching rate with follow up. In the future, larger case series with longer follow-up are necessary to evaluate the relation between notching and radiological and clinical complications.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141802458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-23DOI: 10.1177/17585732241265627
Munish R Krishnan, Joshua D Rajaratnam, Dylan Peiris, Manish Gupta, Estelle Wigmore, Christian Heinrichs
Reverse total shoulder arthroplasty has gained popularity for various shoulder conditions and has evolved over time to accommodate for material changes and design philosophy including inverse materials. The tribological behaviour of shoulder arthroplasty has been extensively studied in relation to biological osteolysis which is a notable concern regarding component loosening. This study aims to assess the wear performance of a vitamin E-stabilised glenosphere or conventional ultra-high-molecular-weight polyethylene glenosphere whilst paired with ceramic or cobalt–chrome–molybdenum inlay in a shoulder joint wear simulator. A cumulative total of five million cycles was utilised with gravimetric and visual analysis of wear. Gravimetric wear was observed to be the lowest when a vitamin E-stabilised glenosphere was paired with a ceramic inlay – demonstrating the greatest wear resistance. Our results demonstrate that the combination of vitamin E-stabilised polyethylene glenosphere and ceramic inlay has improved wear resistance properties in load simulations when compared to other bearing surface combinations. This supports the use of the novel inverse combination in clinical practice to attain longer-term survivorship in reverse total shoulder replacements. Basic Science Study; Tribology
反向全肩关节成形术在治疗各种肩部疾病方面越来越受欢迎，并随着时间的推移不断发展，以适应包括反向材料在内的材料变化和设计理念。肩关节置换术的摩擦学行为与生物骨溶解有关，已被广泛研究，而生物骨溶解是组件松动的一个显著问题。本研究旨在评估维生素 E 稳定胶圈或传统超高分子量聚乙烯胶圈与陶瓷或钴铬钼嵌体在肩关节磨损模拟器中的磨损性能。累计使用了五百万次循环，并对磨损进行了重量和视觉分析。观察发现，当维生素 E 稳定胶圈与陶瓷嵌体搭配时，重力磨损最低，显示出最大的耐磨性。我们的研究结果表明，与其他轴承表面组合相比，维生素 E 稳定聚乙烯胶圈和陶瓷镶嵌层的组合在载荷模拟中具有更好的耐磨性能。这支持了在临床实践中使用这种新型反向组合，以实现反向全肩关节置换术的长期存活。基础科学研究；摩擦学
{"title":"A unique tribological inverted bearing solution for reverse shoulder arthroplasty: Vitamin E and ceramic (unique inverse pairings in rTSR)","authors":"Munish R Krishnan, Joshua D Rajaratnam, Dylan Peiris, Manish Gupta, Estelle Wigmore, Christian Heinrichs","doi":"10.1177/17585732241265627","DOIUrl":"https://doi.org/10.1177/17585732241265627","url":null,"abstract":"Reverse total shoulder arthroplasty has gained popularity for various shoulder conditions and has evolved over time to accommodate for material changes and design philosophy including inverse materials. The tribological behaviour of shoulder arthroplasty has been extensively studied in relation to biological osteolysis which is a notable concern regarding component loosening. This study aims to assess the wear performance of a vitamin E-stabilised glenosphere or conventional ultra-high-molecular-weight polyethylene glenosphere whilst paired with ceramic or cobalt–chrome–molybdenum inlay in a shoulder joint wear simulator. A cumulative total of five million cycles was utilised with gravimetric and visual analysis of wear. Gravimetric wear was observed to be the lowest when a vitamin E-stabilised glenosphere was paired with a ceramic inlay – demonstrating the greatest wear resistance. Our results demonstrate that the combination of vitamin E-stabilised polyethylene glenosphere and ceramic inlay has improved wear resistance properties in load simulations when compared to other bearing surface combinations. This supports the use of the novel inverse combination in clinical practice to attain longer-term survivorship in reverse total shoulder replacements. Basic Science Study; Tribology","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141811274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-23DOI: 10.1177/17585732241263753
Timothy R. Buchanan, Kevin A. Hao, Robert J. Cueto, Victoria E. Bindi, Daniel S. O’Keefe, Keegan M. Hones, Emily K Krisanda, Jonathan O. Wright, Thomas W. Wright, K. Farmer, Aimee M. Struk, Bradley S. Schoch, Joseph J. King
This study sought to characterize the tipping point values (the functional scores that patients deem dysfunctional enough to warrant surgery) for patients undergoing first revision reverse total shoulder arthroplasty (rTSA). This study was a retrospective review of a prospectively collected single-institution database of patients undergoing first revision rTSA between August 2015 and December 2019. Tipping point evaluation utilized preoperative scores including the American Shoulder and Elbow Surgeons (ASES), raw and normalized Constant, Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST), and University of California-Los Angeles (UCLA) scores, and active range of motion including abduction, forward elevation (FE), external rotation (ER), and internal rotation score (IR) prior to elective revision rTSA. We included 125 revision rTSAs. Tipping points were 37.6 ASES score, 30.5 raw Constant score, 35.5 normalized Constant score, 68.1 SPADI, 3.7 SST, 13.2 UCLA score, 64° abduction, 69° FE, 23° ER, and 3.1 IR. Higher SST was found for older patients and patients with a lower body mass index. Lower abduction and FE tipping points were reported in patients undergoing revision rTSA for rotator cuff failure, unexplained pain, and implant wear. These tipping points can help surgeons counsel patients regarding when to undergo revision rTSA. Level III; retrospective cohort study; treatment study.
{"title":"Defining the tipping point for revision reverse shoulder arthroplasty","authors":"Timothy R. Buchanan, Kevin A. Hao, Robert J. Cueto, Victoria E. Bindi, Daniel S. O’Keefe, Keegan M. Hones, Emily K Krisanda, Jonathan O. Wright, Thomas W. Wright, K. Farmer, Aimee M. Struk, Bradley S. Schoch, Joseph J. King","doi":"10.1177/17585732241263753","DOIUrl":"https://doi.org/10.1177/17585732241263753","url":null,"abstract":"This study sought to characterize the tipping point values (the functional scores that patients deem dysfunctional enough to warrant surgery) for patients undergoing first revision reverse total shoulder arthroplasty (rTSA). This study was a retrospective review of a prospectively collected single-institution database of patients undergoing first revision rTSA between August 2015 and December 2019. Tipping point evaluation utilized preoperative scores including the American Shoulder and Elbow Surgeons (ASES), raw and normalized Constant, Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST), and University of California-Los Angeles (UCLA) scores, and active range of motion including abduction, forward elevation (FE), external rotation (ER), and internal rotation score (IR) prior to elective revision rTSA. We included 125 revision rTSAs. Tipping points were 37.6 ASES score, 30.5 raw Constant score, 35.5 normalized Constant score, 68.1 SPADI, 3.7 SST, 13.2 UCLA score, 64° abduction, 69° FE, 23° ER, and 3.1 IR. Higher SST was found for older patients and patients with a lower body mass index. Lower abduction and FE tipping points were reported in patients undergoing revision rTSA for rotator cuff failure, unexplained pain, and implant wear. These tipping points can help surgeons counsel patients regarding when to undergo revision rTSA. Level III; retrospective cohort study; treatment study.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141813419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-23DOI: 10.1177/17585732241263834
Michael A. Gaudiani, Joshua P. Castle, Eric X Jiang, Susan G. Wager, Spencer R Brown, Johnny K Kasto, Matthew A. Gasparro, Alexander S Jurayj, E. Makhni, Vasilios Moutzouros, Stephanie J. Muh
This study aimed to determine if smokers at the time of arthroscopic rotator cuff repair met the minimally clinical important difference and substantial clinical benefit for Patient-Reported Outcomes Measurement Information System Upper Extremity, Depression, and Pain Interference scores in comparison to nonsmoking patients in a retrospective review. Clinical outcomes and Patient-Reported Outcomes Measurement Information System scores were compared between a cohort of nonsmokers and current or former smokers (smokers). Further sub-analysis compared a cohort of nonsmokers propensity-matched 1:1 to a cohort of current/former smokers via age, body mass index, and tear size. A total of 182 patients, 80 smokers and 102 nonsmokers, were included. Smokers had statistically different-sized tears with more rated massive ( P = 0.02) and more reoperations ( P = 0.02). Smokers met substantial clinical benefit thresholds at a lower rate than nonsmokers for Patient-Reported Outcomes Measurement Information System Upper Extremity ( P = 0.03). In the sub-analysis, 74 smokers were matched to 74 nonsmokers. Smokers had a lower change in Patient-Reported Outcomes Measurement Information System Upper Extremity ( P = 0.007) and Patient-Reported Outcomes Measurement Information System Pain Interference ( P = 0.03) postoperatively. Fewer smokers met minimally clinical important difference for Patient-Reported Outcomes Measurement Information System Upper Extremity postoperatively ( P = 0.003) and more had reoperations ( P = 0.02). Overall, smokers demonstrated smaller improvements in function, and pain, and were less likely to meet minimally clinical important differences and substantial clinical benefits for Patient-Reported Outcomes Measurement Information System Upper Extremity at 6 months follow-up when compared to nonsmokers after rotator cuff repair.
{"title":"Worse postoperative outcomes and higher reoperation in smokers compared to nonsmokers for arthroscopic rotator cuff repair","authors":"Michael A. Gaudiani, Joshua P. Castle, Eric X Jiang, Susan G. Wager, Spencer R Brown, Johnny K Kasto, Matthew A. Gasparro, Alexander S Jurayj, E. Makhni, Vasilios Moutzouros, Stephanie J. Muh","doi":"10.1177/17585732241263834","DOIUrl":"https://doi.org/10.1177/17585732241263834","url":null,"abstract":"This study aimed to determine if smokers at the time of arthroscopic rotator cuff repair met the minimally clinical important difference and substantial clinical benefit for Patient-Reported Outcomes Measurement Information System Upper Extremity, Depression, and Pain Interference scores in comparison to nonsmoking patients in a retrospective review. Clinical outcomes and Patient-Reported Outcomes Measurement Information System scores were compared between a cohort of nonsmokers and current or former smokers (smokers). Further sub-analysis compared a cohort of nonsmokers propensity-matched 1:1 to a cohort of current/former smokers via age, body mass index, and tear size. A total of 182 patients, 80 smokers and 102 nonsmokers, were included. Smokers had statistically different-sized tears with more rated massive ( P = 0.02) and more reoperations ( P = 0.02). Smokers met substantial clinical benefit thresholds at a lower rate than nonsmokers for Patient-Reported Outcomes Measurement Information System Upper Extremity ( P = 0.03). In the sub-analysis, 74 smokers were matched to 74 nonsmokers. Smokers had a lower change in Patient-Reported Outcomes Measurement Information System Upper Extremity ( P = 0.007) and Patient-Reported Outcomes Measurement Information System Pain Interference ( P = 0.03) postoperatively. Fewer smokers met minimally clinical important difference for Patient-Reported Outcomes Measurement Information System Upper Extremity postoperatively ( P = 0.003) and more had reoperations ( P = 0.02). Overall, smokers demonstrated smaller improvements in function, and pain, and were less likely to meet minimally clinical important differences and substantial clinical benefits for Patient-Reported Outcomes Measurement Information System Upper Extremity at 6 months follow-up when compared to nonsmokers after rotator cuff repair.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-14DOI: 10.1177/17585732241261659
Alex K Chowdhury, Saad Islam, Tom Ranaboldo, Katharine Shean, K. Wilcocks, Sridhar R Sampalli, Ahmed Elmorsy
Intra-articular corticosteroid injections are frequently utilised in patients with glenohumeral arthritis for diagnostic and therapeutic purposes. A systematic review was performed to assess the relationship between prior corticosteroid injection and infection following shoulder arthroplasty. A search was performed, using databases Medline, EMBASE and CINAHL. Studies with comparative data of post-arthroplasty infection following previous corticosteroid injection versus controls were included. Seven studies fulfilled the inclusion criteria, comprising 87,820 patients. On pooled analysis, previous steroid injection did not increase the overall risk of infection (risk ratio 1.17; confidence interval 1.00–1.37, p = 0.06). On subgroup analysis for timing of injection, one given within 3 months before arthroplasty conferred a greater risk of infection than no injection (risk ratio 2.30; confidence interval 1.13–4.69, p = 0.02) or one given between 3 and 12 months before arthroplasty (risk ratio 3.32; confidence interval 1.43–7.72, p = 0.005). An injection at 3 to 12 months before arthroplasty did not increase the risk of infection over controls (risk ratio 0.89; confidence interval 0.63–1.25, p = 0.50). This review has found there to be a time-dependent relationship between prior corticosteroid injection and infection post-arthroplasty, with an increased risk when performed within three months before arthroplasty. Thus, an interval of at least three months is recommended between injection and arthroplasty.
{"title":"The safety of corticosteroid injection prior to shoulder arthroplasty: A systematic review","authors":"Alex K Chowdhury, Saad Islam, Tom Ranaboldo, Katharine Shean, K. Wilcocks, Sridhar R Sampalli, Ahmed Elmorsy","doi":"10.1177/17585732241261659","DOIUrl":"https://doi.org/10.1177/17585732241261659","url":null,"abstract":"Intra-articular corticosteroid injections are frequently utilised in patients with glenohumeral arthritis for diagnostic and therapeutic purposes. A systematic review was performed to assess the relationship between prior corticosteroid injection and infection following shoulder arthroplasty. A search was performed, using databases Medline, EMBASE and CINAHL. Studies with comparative data of post-arthroplasty infection following previous corticosteroid injection versus controls were included. Seven studies fulfilled the inclusion criteria, comprising 87,820 patients. On pooled analysis, previous steroid injection did not increase the overall risk of infection (risk ratio 1.17; confidence interval 1.00–1.37, p = 0.06). On subgroup analysis for timing of injection, one given within 3 months before arthroplasty conferred a greater risk of infection than no injection (risk ratio 2.30; confidence interval 1.13–4.69, p = 0.02) or one given between 3 and 12 months before arthroplasty (risk ratio 3.32; confidence interval 1.43–7.72, p = 0.005). An injection at 3 to 12 months before arthroplasty did not increase the risk of infection over controls (risk ratio 0.89; confidence interval 0.63–1.25, p = 0.50). This review has found there to be a time-dependent relationship between prior corticosteroid injection and infection post-arthroplasty, with an increased risk when performed within three months before arthroplasty. Thus, an interval of at least three months is recommended between injection and arthroplasty.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141338988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-11DOI: 10.1177/17585732241258069
Eric J Panther, Kevin A. Hao, Matthew R. Patrick, Joseph J. King, Thomas W. Wright, Aimee M. Struk, Jonathan O. Wright, Bradley S. Schoch
Improper sizing of the humeral head component in anatomic total shoulder arthroplasty (ATSA) can overstuff the joint, potentially compromising outcomes. The purpose of this study was to validate a novel method of evaluating glenohumeral joint overstuffing in which superoinferior and mediolateral overstuffing can be evaluated independently relative to the native humeral anatomy. We identified 25 patients who underwent ATSA and the best Grashey radiograph taken within 1 year of follow-up was assessed using our proposed technique. First, a circle overlaying the implanted humeral head was made. Then, Iannotti's Perfect Circle (IPC) was drawn as originally described. Measurements of superior and medial overstuffing were made using our proposed axes. Inter-rater reliability was assessed by computing interclass correlation coefficients (ICC) using a one-way model. Measurements were summarized as the mean and range, with positive values denoting overstuffing. The inter-rater reliability for all measurements was excellent (ICC > 0.9). Compared to our method, the IPC method would have missed 77% of overstuffed cases. We present a reproducible method to assess glenohumeral joint overstuffing in ATSA. This technique addresses limitations of other methods that underestimate overstuffing. Further study is needed to establish a clinically significant value of overstuffing based on the proposed method.
{"title":"A reproducible method for evaluating the degree and direction of overstuffing of the humeral head component in anatomic total shoulder arthroplasty","authors":"Eric J Panther, Kevin A. Hao, Matthew R. Patrick, Joseph J. King, Thomas W. Wright, Aimee M. Struk, Jonathan O. Wright, Bradley S. Schoch","doi":"10.1177/17585732241258069","DOIUrl":"https://doi.org/10.1177/17585732241258069","url":null,"abstract":"Improper sizing of the humeral head component in anatomic total shoulder arthroplasty (ATSA) can overstuff the joint, potentially compromising outcomes. The purpose of this study was to validate a novel method of evaluating glenohumeral joint overstuffing in which superoinferior and mediolateral overstuffing can be evaluated independently relative to the native humeral anatomy. We identified 25 patients who underwent ATSA and the best Grashey radiograph taken within 1 year of follow-up was assessed using our proposed technique. First, a circle overlaying the implanted humeral head was made. Then, Iannotti's Perfect Circle (IPC) was drawn as originally described. Measurements of superior and medial overstuffing were made using our proposed axes. Inter-rater reliability was assessed by computing interclass correlation coefficients (ICC) using a one-way model. Measurements were summarized as the mean and range, with positive values denoting overstuffing. The inter-rater reliability for all measurements was excellent (ICC > 0.9). Compared to our method, the IPC method would have missed 77% of overstuffed cases. We present a reproducible method to assess glenohumeral joint overstuffing in ATSA. This technique addresses limitations of other methods that underestimate overstuffing. Further study is needed to establish a clinically significant value of overstuffing based on the proposed method.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141360268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.1177/17585732241259165
Akasha Barreto Vega, Prem N Ramkumar, H. Kassam, R. A. Navarro
The purpose of this review is to provide an overview of the integration of technological advancements in orthopedic shoulder surgery. Recent technological advancements in orthopedic shoulder surgery include predictive analytics, computer-navigated instrumentation for operative planning, extended reality, and robotics. Separately, these advancements provide distinct methodological attempts to improve surgical experiences and outcomes. Together, these technologies can provide orthopedic surgeons with the tools and capabilities to improve patient care and communication in shoulder arthroplasty. From artificial intelligence-generated predictive analytics to extended reality and robotics, technical innovations may lead to improvements in patient education, surgical accuracy, interdisciplinary communication, and outcomes. A comprehensive narrative review was conducted to explore the technological advancements of orthopedic shoulder arthroplasty. Our findings emphasized the impact of these advancements, exemplified by early enhancements in efficacy and safety. However, certain challenges remain, such as a lack of reproducibly improved outcomes and cost considerations. While the reviewed studies indicate hope for improving shoulder arthroplasty, the true cost-effectiveness and applicability remains to be determined, indicating the need for further research.
{"title":"Advanced technology in shoulder arthroplasty surgery: Artificial intelligence, extended reality, and robotics","authors":"Akasha Barreto Vega, Prem N Ramkumar, H. Kassam, R. A. Navarro","doi":"10.1177/17585732241259165","DOIUrl":"https://doi.org/10.1177/17585732241259165","url":null,"abstract":"The purpose of this review is to provide an overview of the integration of technological advancements in orthopedic shoulder surgery. Recent technological advancements in orthopedic shoulder surgery include predictive analytics, computer-navigated instrumentation for operative planning, extended reality, and robotics. Separately, these advancements provide distinct methodological attempts to improve surgical experiences and outcomes. Together, these technologies can provide orthopedic surgeons with the tools and capabilities to improve patient care and communication in shoulder arthroplasty. From artificial intelligence-generated predictive analytics to extended reality and robotics, technical innovations may lead to improvements in patient education, surgical accuracy, interdisciplinary communication, and outcomes. A comprehensive narrative review was conducted to explore the technological advancements of orthopedic shoulder arthroplasty. Our findings emphasized the impact of these advancements, exemplified by early enhancements in efficacy and safety. However, certain challenges remain, such as a lack of reproducibly improved outcomes and cost considerations. While the reviewed studies indicate hope for improving shoulder arthroplasty, the true cost-effectiveness and applicability remains to be determined, indicating the need for further research.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141384456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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