JSES reviews, reports, and techniques最新文献

{"title":"How do GLP-1 receptor agonists influence the progression of shoulder pathology? A matched cohort analysis","authors":"William R. Davis BS ,&nbsp;Nicholas C. Bank MD ,&nbsp;Bradley J. Lauck BA ,&nbsp;Robert A. Creighton MD ,&nbsp;R. Justin Mistovich MD, MBA","doi":"10.1016/j.xrrt.2025.100613","DOIUrl":"10.1016/j.xrrt.2025.100613","url":null,"abstract":"<div><h3>Background</h3><div>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for managing type 2 diabetes mellitus (T2DM) and obesity due to their proven metabolic benefits. However, their impact on musculoskeletal conditions, particularly in non-weight-bearing joints such as the shoulder joint, remains unclear. This study aimed to determine whether GLP-1RA use was associated with the development of shoulder pathologies (glenohumeral osteoarthritis, adhesive capsulitis, atraumatic rotator cuff tears, and shoulder fractures) over a 5-year period.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed using the TriNetX research database. Adult patients prescribed GLP-1RAs between 2017 and 2019 were identified and stratified into 3 cohorts based on obesity (body mass index ≥30) and T2DM status: (1) obese T2DM, (2) nonobese T2DM, and (3) nonobese non-T2DM. Within each group, GLP-1RA users were 1:1 propensity score matched to nonusers. Primary outcomes (glenohumeral osteoarthritis, adhesive capsulitis, atraumatic rotator cuff tears, and shoulder fractures) were evaluated over a 5-year period, and secondary outcomes (hemoglobin A1c and body mass index) were assessed over a 2-year period. Hazard ratios (HRs) with 95% confidence intervals (CIs) were used to compare incidence between GLP-1RA users and nonusers.</div></div><div><h3>Results</h3><div>At 5-year follow-up, GLP-1RA use was associated with higher incidence rates of glenohumeral osteoarthritis, adhesive capsulitis, and atraumatic rotator cuff tears across all subgroups as compared to nonusers. The highest increased risk was observed for adhesive capsulitis, particularly in the obese nondiabetic subgroup (HR: 2.465; 95% CI [3.173-1.916]). Shoulder fracture incidence was lower among GLP-1RA users with both obesity and T2DM (HR: 0.903; 95% CI [0.827-0.987]) but did not differ significantly in patients with obesity without T2DM or in nonobese patients with diabetes.</div></div><div><h3>Conclusions</h3><div>GLP-1RA therapy was associated with an increased incidence of certain shoulder pathologies, most notably adhesive capsulitis, suggesting GLP-1RAs may have adverse musculoskeletal effects in the shoulder joint. These findings highlight the need for future prospective studies to confirm these associations.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100613"},"PeriodicalIF":0.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736789","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}

{"title":"Anterior shoulder dislocation with coracoid fracture treated with Bristow procedure: a case report and literature review","authors":"Fotios Panagopoulos MD,&nbsp;Vasileios Giannatos MD,&nbsp;Panagiotis Antzoulas MD,&nbsp;Michail Kroustalakis MD,&nbsp;Konstantinos Koutas MD,&nbsp;Zinon Kokkalis MD","doi":"10.1016/j.xrrt.2025.100607","DOIUrl":"10.1016/j.xrrt.2025.100607","url":null,"abstract":"","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100607"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736785","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}

{"title":"All-cause cancellation of primary total shoulder arthroplasty at a single institution: prevalence, reasons and risk factors","authors":"Vishal Shankar BA ,&nbsp;Cameron Smith BA, MPH ,&nbsp;Savino Stallone BS ,&nbsp;Yungtai Lo PhD ,&nbsp;Elilary Montilla MD ,&nbsp;Konrad I. Gruson MD","doi":"10.1016/j.xrrt.2025.100609","DOIUrl":"10.1016/j.xrrt.2025.100609","url":null,"abstract":"<div><h3>Background</h3><div>Cancellation of elective total shoulder arthroplasty (TSA), particularly those occurring on or just before the surgical date, results in disruption to the surgeon's schedule and operating room flow with resulting negative financial implications. The prevalence and risk factors for all-cause cancellations remain poorly defined.</div></div><div><h3>Methods</h3><div>A retrospective review of an institutional database was performed to identify all-cause cancellations of primary TSA from January 2016 through December 2024. Patient demographics and surgical data, including age, insurance type, distance from home-to-clinic, socioeconomic status based on the Area Deprivation Index and arthroplasty type was tabulated. The time from booking and cancellation to planned arthroplasty, and reason for cancellation, in addition to whether the surgery was rescheduled and ultimately performed, was documented.</div></div><div><h3>Results</h3><div>There were 489 total cases booked during the study period by a single surgeon, of which 127 (25.9%) were canceled prior to the surgical date. There were 225 anatomic and 264 reverse TSAs, and 318 (65%) patients were female. Of the cancellations, 50 (39.4%) rescheduled and underwent TSA at a median of 98 days (interquartile range 47,238) later. A longer time between booking and planned surgery (OR 1.01, 95% confidence interval (CI) 1.001-1.02, <em>P</em> = .012) and presentation to the emergency department for any reason within 1 year prior to planned surgery were significantly associated with cancellation. Among cancellations, patient-driven cancellations (OR 3.74, 95% CI 1.45-9.60, <em>P</em> = .008) were associated with a significantly higher likelihood of not rescheduling surgery, whereas being married was associated with a decreased risk for not rescheduling (OR 0.36, 95% CI 0.15-0.84, <em>P</em> = .018).</div></div><div><h3>Discussion</h3><div>Identification of the factors associated with cancellation of elective TSA may serve as the basis for developing preoperative interventions aimed specifically at those more likely to cancel.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100609"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736786","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}

{"title":"Treatment of isolated greater tuberosity fractures: a scoping review","authors":"Mathilde Abildgaard MD ,&nbsp;David Karimi MD ,&nbsp;Kristine Rask Andreasen MD ,&nbsp;Dennis Karimi MD, PhD ,&nbsp;Tazio Maleitzke MD ,&nbsp;Per Hölmich MD, DMSc ,&nbsp;Adam Witten MD, PhD","doi":"10.1016/j.xrrt.2025.100611","DOIUrl":"10.1016/j.xrrt.2025.100611","url":null,"abstract":"<div><h3>Background</h3><div>There are no evidence-based guidelines to support the management of isolated greater tuberosity fractures. While the choice between nonoperative and operative treatment is generally based on the degree of fracture displacement, the definition of an acceptable displacement continues to be debated. Consequently, the ideal management of these fractures can be a therapeutic challenge. The objective of this study was to create an overview of the literature investigating the treatment of isolated greater tuberosity fractures.</div></div><div><h3>Methods</h3><div>A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines for scoping reviews (PRISMA-ScR). Electronic databases MEDLINE, EMBASE, SPORTDiscus, and CINAHL were systematically searched from inception to September 29, 2024. Original studies investigating the treatment of isolated greater tuberosity fractures were eligible for inclusion. Screening of studies was independently performed by 3 reviewers. Data items were extracted using a standardized charting form. Risk of bias of the included studies was assessed by 2 independent reviewers using the Newcastle-Ottawa Quality Assessment Scale.</div></div><div><h3>Results</h3><div>3.788 records were identified in the search, 296 were retrieved for full-text screening, of which 59 were included. No randomized controlled trials were identified. 88% of the included studies were retrospective and 98% had a moderate or high risk of bias. Most of the included studies investigated operative treatment of displaced fractures (defined as &gt;5 mm) in patient populations with a mean age between 40 and 60 years. Few studies investigated nonoperative treatment and treatment in young (&lt;40 years) or elderly (&gt;60 years) patients. Detailed fracture characteristics were not consistently reported. Accordingly, the size of the fragment was reported in 8% of the included studies, fractures were subclassified into avulsion, split or depression type in 29% of the included studies, and the direction of fragment displacement was reported in 34% of the included studies.</div></div><div><h3>Conclusion</h3><div>The literature regarding the treatment of isolated greater tuberosity fractures is comprised of studies with a moderate to high risk of bias and a lack of randomized controlled trials. A 5 mm fracture displacement threshold is often used to guide treatment, though it has not been validated in clinical studies. High-quality studies are needed to establish evidence-based guidelines and improve clinical decision-making.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 2","pages":"Article 100611"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145929078","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}

{"title":"Arthroscopic bone block using an autologous iliac crest graft and concomitant remplissage for severe bipolar bone loss in a young patient with anterior shoulder instability: a case report","authors":"Irina Todiraş MD ,&nbsp;Christina Lorenz MD ,&nbsp;Markus Scheibel PD, MD ,&nbsp;Florian Freislederer MD","doi":"10.1016/j.xrrt.2025.100606","DOIUrl":"10.1016/j.xrrt.2025.100606","url":null,"abstract":"","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100606"},"PeriodicalIF":0.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736788","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}

{"title":"Débridement, antibiotics, and implant retention versus 2-stage revision for infected total elbow arthroplasty: a systematic review and meta-analysis","authors":"Ankur Khanna BS,&nbsp;Christopher M. Hart MD,&nbsp;Tristan B. Weir MD,&nbsp;Micah Nieboer MD,&nbsp;Larry J. Prokop MLIS,&nbsp;Jonathan D. Barlow MD,&nbsp;Jennifer Tangtiphaiboontana MD,&nbsp;Joaquin Sanchez-Sotelo MD,&nbsp;Mark E. Morrey MD","doi":"10.1016/j.xrrt.2025.100603","DOIUrl":"10.1016/j.xrrt.2025.100603","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infection after total elbow arthroplasty (TEA) is associated with substantial morbidity and the need for revision surgery. The aim of this systematic review and meta-analysis was to summarize studies on 2-stage exchange and débridement, antibiotics, and implant retention (DAIR) to determine differences in rates of recurrent infection, risk factors for recurrent infection, noninfectious complications, and functional outcomes.</div></div><div><h3>Methods</h3><div>A systematic search was conducted of the MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science databases in March 2024 to identify studies on infected TEAs treated with either 2-stage revision surgery or DAIR. Exclusion criteria included duplicate publications, review articles, and studies with a mean follow-up of less than 1 year. Fourteen studies were included in the final analysis. Data abstracted included demographics, treatment modalities, bacterial speciation, rates of recurrent infection, and functional outcomes (range of motion data and Mayo Elbow Performance Score.</div></div><div><h3>Results</h3><div>Two hundred ninety infected TEAs were included across all 14 studies, 131 treated with DAIR and 159 treated with 2-stage exchange. The overall pooled random-effects rate of recurrent infection was 34% (95% confidence interval: 21%-47%). The rate of recurrent infection was significantly lower following 2-stage exchange compared to DAIR (18% vs. 51%, <em>P</em> = .004). The overall pooled rate of noninfectious complications was 34% (95% confidence interval: 22%-46%). With the numbers available, the rate of noninfectious complications between 2-stage exchange and DAIR was smaller for 2-stage exchange, although the difference did not achieve statistical significance (27% vs. 43%, <em>P</em> = .244). Patients infected with coagulase-negative <em>Staphylococci</em> experienced a higher rate of recurrent infection than those infected with other species (44% vs. 14%), although again this difference did not reach statistical significance (<em>P</em> = .060). In patients undergoing 2-stage exchange, incomplete cement removal was associated with a significantly higher rate of recurrent infection than complete removal (56% vs. 19%, <em>P</em> = .001), but intentional retention of 1 component was not significantly associated with a higher rate of recurrent infection (37% vs. 20%, <em>P</em> = .315).</div></div><div><h3>Discussion</h3><div>The results of this systematic review and meta-analysis of the outcomes associated with the treatment of TEA periprosthetic joint infection with either DAIR or 2-stage reimplantation, 2-stage exchange was associated with a lower rate of recurrent infection. Incomplete cement removal was a risk factor for recurrent infection. Although it did not reach significance, it appeared that infection with coagulase-negative <em>Staphylococci</em> could also be a risk factor for failure of infection eradication.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100603"},"PeriodicalIF":0.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736726","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}

{"title":"Arthroscopic anterior glenoid reconstruction using distal tibial allograft with suture button fixation: 2-year postoperative clinical outcomes","authors":"Grant Greaves BEng, MD,&nbsp;Ailar Ramadi PhD,&nbsp;Lauren Beaupre PhD,&nbsp;Dylan Alexander BSc, MSc (PT candidate),&nbsp;Martin Bouliane MD","doi":"10.1016/j.xrrt.2025.100602","DOIUrl":"10.1016/j.xrrt.2025.100602","url":null,"abstract":"<div><h3>Background</h3><div>Anterior glenohumeral instability is a common cause of shoulder instability. Bony reconstruction with distal tibial allograft (DTA) is a relatively new technique with promising results. Screw fixation of the graft comes with certain risks including hardware complications requiring revision surgery, so a novel technique, arthroscopic DTA with double suture-button fixation, has been proposed. The purpose of our study was therefore to report the outcomes of arthroscopic DTA anterior glenoid reconstruction with double suture-button fixation.</div></div><div><h3>Methods</h3><div>A single-surgeon, single-center, mixed retrospective/prospective cohort review of patients who underwent arthroscopic DTA glenoid reconstruction with double-button suture anchor fixation between 2018 and 2022 in Alberta, Canada, was performed. The study included adult patients at least 18 years old at time of study with at least 13% glenoid bone loss and 2 years of follow-up. Chart reviews and telephone interviews were completed to assess for radiographic and clinical outcomes. Primary outcomes were failure rate, complication rate including infection, neurovascular injury, revision rate, reoperation rate, and patient-reported outcome measures.</div></div><div><h3>Results</h3><div>Forty-eight patients with mean age 31 ± 10 years (range 18-63) and 43 (90%) males were included. Mean follow-up was 63 ± 15 months (range 24-78 months). Seventeen patients (35%) had previous stabilization surgery. Mean preoperative glenoid bone loss was 32 ± 8%. Objective recurrent instability was observed in 10 (21%) patients. One (2%) patient required reoperation for loose suture material. Other complications include 1 (2%) pulmonary embolism and 1 (2%) neurovascular injury, both of which occurred in the same patient. The study was not powered to identify risk factors for failure, and odds ratios (ORs) did not achieve statistical significance for patients with a history of epilepsy (OR 4.4, <em>P</em> = .15), smoking (OR 6.8, <em>P</em> = .08), and substance use (OR 1.8, <em>P</em> = .81). Twenty-three participants (53%) completed a telephone interview with the following results: subjective persistent instability 9 (39%), chronic stiffness 9 (39%), mechanical symptoms 16 (70%), overall Single Assessment Numeric Evaluation score 87 ± 9, average Visual Analog Score 1.1 ± 1.5, and 20 (87%) were 'satisfied' or 'very satisfied' with their surgery.</div></div><div><h3>Conclusion</h3><div>The rate of recurrent instability is 21% in this challenging population. Reoperation rate for symptomatic hardware was 2%, and the other complication rate was 2%. While DTA reconstruction with suture button fixation can be considered an option in patients with risk factors for failure, patients should be counseled on the risk of recurrent instability and need for reoperation.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100602"},"PeriodicalIF":0.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736787","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}

{"title":"Current outcomes of triceps-sparing elbow arthroplasties: a systematic review","authors":"James R. Satalich MD ,&nbsp;Shahabeddin Yazdanpanah MS ,&nbsp;Grayson M. Talaski BSE ,&nbsp;Devi-Preetham Veeramgari BS ,&nbsp;Nicholas R. Kiritsis BS ,&nbsp;John W. Cyrus MS ,&nbsp;Benjamin P. Cassidy MD ,&nbsp;Matthew S. Smith MD ,&nbsp;Jennifer L. Vanderbeck MD","doi":"10.1016/j.xrrt.2025.100604","DOIUrl":"10.1016/j.xrrt.2025.100604","url":null,"abstract":"<div><h3>Background</h3><div>Total elbow arthroplasty (TEA) is a reconstructive option for fractures, arthritis, and tumors, particularly in older adults. Approaches for the procedure can be categorized into triceps-sparing (TS) or triceps-detaching (TD). TD approaches are well-studied, but are associated with many complications such as infections, limited range of motion, and triceps insufficiency. Despite being more technically demanding, TS approaches are rising in popularity due to preservation of the triceps insertion. This study consolidates the most recent literature on TS-TEAs and TS elbow hemiarthroplasties (EHAs) to better inform updated clinical decision-making.</div></div><div><h3>Methods</h3><div>A PROSPERO-registered systematic review was conducted on March 10, 2025, searching PubMed, Ovid-Embase, MEDLINE, and Web of Science for studies published since 2020 that investigate TS elbow arthroplasty findings in adults. Extracted outcomes included demographics, range of motion metrics, and complications. Frequency-weighted means, t-tests, and chi-square tests were accordingly utilized in R Studio for statistical analyses.</div></div><div><h3>Results</h3><div>Eight moderate-quality retrospective studies were identified (5 TS-TEA and 3 TS-EHA) out of 290. Patients (n = 252; TS-TEA 195; TS-EHA 57) had average ages of 64.5 ± 12.5 and 73.1 ± 10.6, with average follow-ups of 43.8 ± 39.5 and 56.3 ± 20.0 months for TS-TEA and TS-EHA, respectively. Average flexion degrees were 129.7° ± 19.5 and 129.0° ± 13.8, followed by extension deficits at 17.9° ± 17.3 and 19.8° ± 12.9, respectively. Average postoperative prosupination arc ranges were 140.6°-144.6° and 155°-171°, respectively. Complication rates were 22.9% after TS-TEA and 54.4% after TS-EHA, characterized by literature-compared high rates of ulnar nerve symptoms and heterotopic ossification, but low rates of infection and triceps insufficiency.</div></div><div><h3>Conclusion</h3><div>TS approaches, either in TEA or EHA, are reasonable options for surgeons today. Further studies are recommended for more granular and consistent elucidation, with arthroplasty approaches remaining individualized to patient needs and surgeon preferences.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100604"},"PeriodicalIF":0.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617702","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}

{"title":"Rotator cuff repair and biologic augmentation—what do we know?","authors":"Adam J. Tagliero MD ,&nbsp;Erick M. Marigi MD ,&nbsp;Christopher M. Hart MD ,&nbsp;Tristan B. Weir MD ,&nbsp;Gavin H. Ward BA ,&nbsp;Christopher L. Camp MD ,&nbsp;Jonathan D. Barlow MD ,&nbsp;John W. Sperling MD, MBA ,&nbsp;Joaquin Sanchez-Sotelo MD, PhD","doi":"10.1016/j.xrrt.2025.100605","DOIUrl":"10.1016/j.xrrt.2025.100605","url":null,"abstract":"<div><h3>Background</h3><div>Despite advancements in rotator cuff repair (RCR) techniques, failure of tendon healing remains common. In recent years, there has been an increasing body of work assessing the healing environment of the injured rotator cuff and exploring which adjuncts may be suitable to augment repairs.</div></div><div><h3>Methods</h3><div>In this review, we summarize the best available literature regarding the biology of rotator cuff healing and the use of platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), scaffold-, and graft-based augmentations to RCR to guide the treating clinician.</div></div><div><h3>Results</h3><div>Proposed treatment modalities range from injection-based augmentation such as PRP and BMAC to scaffold and graft-based augmentations at the time of RCR.</div></div><div><h3>Conclusion</h3><div>The field of biologic augmentation for RCR is rapidly evolving and has demonstrated substantial potential in improving structural integrity and healing rates. PRP, BMAC, as well as scaffold- or graft-based strategies, have all shown promise; however, variability in study methodology, preparation techniques, and clinical outcomes continue to limit definitive recommendations. Key challenges remain, including the need for optimization and standardization of biologic formulations, patient selection criteria, and cost-effective analyses. The need for well-powered, high-quality randomized controlled trials with standardized protocols are paramount to guiding clinical decision-making. The need to optimize RCR is clear, and the interest is evident in the numerous studies in the field. Future studies should aim to establish clear guidelines for biologic augmentation, ensuring that evidence-based applications can optimize patient outcomes in the future.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100605"},"PeriodicalIF":0.0,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736727","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}

{"title":"Hospital, regional, and policy-level variations in shoulder arthroplasty prices: a Nationwide database study","authors":"Devika A. Shenoy BS,&nbsp;Katelyn E. Parsons BS,&nbsp;Kevin A. Wu MD,&nbsp;Aaron D. Therien MS,&nbsp;Yiqiu Zhang BS,&nbsp;Amanda Hayes MD,&nbsp;Christian A. Pean MD, MS,&nbsp;Christopher S. Klifto MD,&nbsp;William C. Eward MD, DVM","doi":"10.1016/j.xrrt.2025.100601","DOIUrl":"10.1016/j.xrrt.2025.100601","url":null,"abstract":"<div><h3>Background</h3><div>Surgical reconstruction via hemiarthroplasty, anatomic total shoulder arthroplasty (aTSA), or reverse total shoulder arthroplasty (rTSA) is a common approach for treatment of various shoulder pathologies. Little is known about variations in negotiated payor rates for these procedures. The objective of this study was to examine hospital, regional, and policy-level factors associated with variations in negotiated rates for total shoulder arthroplasty (TSA) and hemiarthroplasty across the United States.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis was performed with 2024 payor rate data from the Turquoise Health Database, using current procedural terminology codes for hemiarthroplasty (23470) and rTSA/aTSA (23472). Variables of interest were downloaded from publicly available sources, including hospital size, payor class, metropolitan/nonmetropolitan classification, regional household income, and Area Deprivation Index. State-level policies included Medicaid expansion status, certificate-of-need (CON) status, nurse practitioner scope-of-practice regulations, and participation in the All-Payer Claims Database (APCD). Multivariable linear regressions were used to assess associations between payor rates and variables of interest.</div></div><div><h3>Results</h3><div>In total, 516,904 total rates were evaluated (256,422 hemiarthroplasty; 260,480 rTSA/aTSA). The unadjusted mean negotiated rate was $9,082 (standard deviation: $1,182) for hemiarthroplasty and $10,840 (standard deviation: $1,405) for TSA. In a separate multivariable analysis, the mean rate difference was $68 (95% CI: $35-$102). Hospital bed capacity was tied to variations in both cohorts. Metropolitan hospitals reported higher payor rates for both hemiarthroplasty (+$2,151.46) and rTSA/aTSA (+$879.73) in comparison to nonmetropolitan hospitals. Medicaid expansion was associated with higher rates for both cohorts, while increased nurse practitioner scope of practice, CON status, and APCD database participation were associated with lower rates (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Shoulder arthroplasty negotiated payor rates show large variations and are associated with several factors, including hospital size, payor class, and regional factors. Mean TSA rates were $68 higher, a clinically insignificant amount. States with CON laws and APCD database participation have lower payor rates while states with Medicaid expansion have higher rates. These findings underscore significant variations in how hospitals and payors negotiate rates for shoulder arthroplasty, emphasizing the many factors that play a role in shaping surgical costs.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100601"},"PeriodicalIF":0.0,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617705","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}