Journal of shoulder and elbow arthroplasty最新文献

Background: Periprosthetic joint infection (PJI) is a complication of arthroplasty surgery with significant morbidity and mortality. Surgical helmets are a possible source of infection. Pre-existing dust and microorganisms on its surface may be blown into the surgical field by the helmet ventilation system.

Methods: Twenty surgical helmets at our institution were assessed through microscopy and polymerase chain reaction testing. Helmets were arranged with agar plates under the front and rear outflow vents. Helmets ran while plates were exchanged at different time points. Bacterial growth was assessed via colony counts and correlated with fan operating time. Gram staining and 16S sequencing were performed to identify bacterial species.

Results: The primary microbiological contaminate identified was Burkholderia. There was an inverse relationship between colony formation and fan operating time. The highest number of colonies was found within the first minute of fan operating time. There was a significant decrease in the number of colonies formed from the zero-minute to the three (27 vs 5; P = <.01), four (27 vs 3; P = <.01), and five-minute (27 vs 4; P = <.01) time points for the front outflow plates. A significant difference was also observed between the one-minute and four-minute time points (P = .046).

Conclusion: We observed an inverse relationship between bacterial spread helmet fan operation time, which may correlate with dispersion of pre-existing contaminates. To decrease contamination risk, we recommend that helmets are run for at least 3 min prior to entering the operating room.

Background: The demand and incidence of anatomic total shoulder arthroplasty (aTSA) procedures is projected to increase substantially over the next decade. There is a paucity of accurate risk prediction models which would be of great utility in minimizing morbidity and costs associated with major post-operative complications. Machine learning is a powerful predictive modeling tool and has become increasingly popular, especially in orthopedics. We aimed to build a ML model for prediction of major complications and readmission following primary aTSA.

Methods: A large California administrative database was retrospectively reviewed for all adults undergoing primary aTSA between 2015 to 2017. The primary outcome was any major complication or readmission following aTSA. A wide scope of standard ML benchmarks, including Logistic regression (LR), XGBoost, Gradient boosting, AdaBoost and Random Forest were employed to determine their power to predict outcomes. Additionally, important patient features to the prediction models were indentified.

Results: There were a total of 10,302 aTSAs with 598 (5.8%) having at least one major post-operative complication or readmission. XGBoost had the highest discriminative power (area under receiver operating curve AUROC of 0.689) of the 5 ML benchmarks with an area under precision recall curve AURPC of 0.207. History of implant complication, severe chronic kidney disease, teaching hospital status, coronary artery disease and male sex were the most important features for the performance of XGBoost. In addition, XGBoost identified teaching hospital status and male sex as markedly more important predictors of outcomes compared to LR models.

Conclusion: We report a well calibrated XGBoost ML algorithm for predicting major complications and 30-day readmission following aTSA. History of prior implant complication was the most important patient feature for XGBoost performance, a novel patient feature that surgeons should consider when counseling patients.

Purpose: To identify prior studies of arthroscopic glenoid component removal after total shoulder arthroplasty (TSA) and understand indications, techniques and patient outcomes.

Methods: A search of the English language literature on arthroscopic removal of the glenoid component (ARGC) after TSA published between 2005 and 2021 was performed from MEDLINE and EMBASE databases. Articles with ARGC after TSA were identified and we recorded article characteristics as well as patient demographics and outcomes contained within the studies.

Results: A total of six publications (two case reports and four retrospective case series) detailing the outcome of ARGC performed on twenty-five shoulders were identified. The average time from index procedure to glenoid removal was 117 months and mean age at time of ARGC was 75 years. Although patient reported outcomes measures (PROMs) varied in type and reporting style, all articles reported improvements in PROMs. Twenty patients in this systematic review were evaluated for post-operative complications and the complication rate was found to be 15% (n = 3). There were 2 cases (18%) of superior migration of the humeral head relative to the glenoid and no reported cases of anterior or posterior humeral head subluxation. Two of 25 patients (8%) underwent subsequent open revision procedures.

Conclusions: The limited number of publications in this systematic review demonstrates that ARGC after TSA can result in improvements in both pain and PROMs. This less-invasive arthroscopic technique may be an alternative to open revision for lower demand patients; however, future prospective, comparative studies are necessary to better define indications.

Introduction: The literature has consistently demonstrated utilization disparities in joint replacement procedures, though no studies have evaluated disparities in total shoulder arthroplasty with regard to operative volume.

Methods: We queried the New York (NY) Statewide Planning and Research Cooperative System (SPARCS) database for 32 410 total shoulder arthroplasties performed between 2009 and 2017. Patients were identified using Clinical Classifications Software code 154 for Non-Hip/Knee Arthroplasty and All Patient Refined-Diagnosis Related Group code 322 for Shoulder. Racial groups included Hispanic, non-Hispanic white, non-Hispanic black, and Other. High-volume centers were facilities that performed 2 standard deviations above the mean annual procedures. Utilization rates were calculated by dividing total shoulder arthroplasties per group by the 2010 NY Census population of that group. The Fisher exact test was used to determine significance.

Results: Total shoulder arthroplasty utilization increased from 43/100 000 to 73/100 000, two-thirds of which was driven by an increase in white resident utilization. More White residents per 100 000 underwent shoulder arthroplasty than Black, Hispanic, and Other residents per 100 000 residents of their respective race. White residents were 90% more likely than Hispanic residents to undergo total shoulder arthroplasty at high-volume centers (P = .04). There were no differences in utilization rate regarding operative volume comparing Black or Other residents to White residents. More females underwent total shoulder arthroplasty than males, though there was no difference in utilization rate regarding operative volume.

Conclusion: Though total shoulder arthroplasty utilization nearly doubled, disparities persisted across gender and minority groups particularly in Hispanic utilization as White residents were 90% more likely than Hispanic residents to undergo shoulder arthroplasty at high-volume centers.

Purpose: The purpose of this review is to describe the role of altered joint biomechanics in reverse shoulder arthroplasty and to propose a rehabilitation protocol for a cuff-deficient glenohumeral joint based on the current evidence.Methods and Materials: The proposed rehabilitation incorporates the principles of pertinent muscle loading while considering risk factors and surgical complications.

Results: In light of altered function of shoulder muscles in reverse arthroplasty, scapular plane abduction should be more often utilized as it better activates deltoid, teres minor, upper trapezius, and serratus anterior. Given the absence of supraspinatus and infraspinatus and reduction of external rotation moment arm of the deltoid in reverse arthroplasty, significant recovery of external rotation may not occur, although an intact teres minor may assist external rotation in the elevated position.

Conclusion: Improving the efficiency of deltoid function before and after reverse shoulder arthroplasty is a key factor in the rehabilitation of the cuff deficient shoulders. Performing exercises in scapular plane and higher abduction angles activates deltoid and other important muscles more efficiently and optimizes surgical outcomes.

Objective: Recent reports have shown that outpatient shoulder arthroplasty (SA) may be a safe alternative to inpatient management in appropriately selected patients. The purpose was to review the literature reporting on outpatient SA.

Methods: A systematic review of publications on outpatient SA was performed. Included publications discussed patients who were discharged on the same calendar day or within 23 hours from surgery. Articles were categorized by discussions on complications, readmissions, and safety, patient selection, pain management strategies, cost effectiveness, and patient and surgeon satisfaction.

Results: Twenty-six articles were included. Patients undergoing outpatient SA were younger and with a lower BMI than those undergoing inpatient SA. Larger database studies reported more medical complications for patients undergoing inpatient compared to outpatient SA. Articles on pain management strategies discussed both single shot and continuous interscalene blocks with similar outcomes. Both patients and surgeons reported high levels of satisfaction following outpatient SA, and cost analysis studies demonstrated significant cost savings for outpatient SA.

Conclusion: In appropriately selected patients, outpatient SA can be a safe, cost-saving alternative to inpatient care and may lead to high satisfaction of both patients and physicians, though further studies are needed to clarify appropriate utilization of outpatient SA.

Introduction: Acromial pathologies (AP), such as acromial stress reaction (ASR), acromial stress occult fracture (ASOF), and acromial stress fracture (ASF), are known as complications that deteriorate the clinical score and patient satisfaction after reverse total shoulder arthroplasty (RSA). Several factors that increase stress on the acromion have been reported as risk factors for AP, but this is also unclear. Thecoracoacromial ligament (CAL) is a structure that distributes the stress loading on such an acromion, although its importance has been mentioned, there is a lack of research. Therefore, we investigated the incidence of AP according to the preservation of the CAL and whether it is a risk factor.

Methods: The study was retrospectively conducted on patients who underwent RSA from 2016 and 2018. Patients with CAL transection was classified into group 1 and CAL preservation was classified into group 2. ASR and ASOF were identified through symptoms and ultrasound, and ASF identified through simple radiograph or computed tomography. The incidence of AP in each group was checked and compared.

Results: Of the total of 265 patients. Among 197 cases of group 1, 21 cases of ASR(10.7%), 28 cases of ASOF (14.2%),10 cases of ASF (5.1%), and 59 cases of total AP (29.4%). Among 68 cases in group 2, 2 cases (2.9%) of ASR, 6 cases of ASOF(8.8%), 1 case of ASF (1.5%), and 9 cases of total AP (13.2%). It was confirmed that ASR and ASOP were significantly decreased in the group preserving CAL. (P = .008).

Conclusion: In the case of preservation of CAL during surgery, it was confirmed that the incidence of ASR, ASOF was reduced. Therefore, preservation of CAL can be regarded as a modifiable risk factor that can reduce the risk of AP by distributing the stress applied to acromion after RSA surgery.