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Humeral loosening is a rare complication in reverse shoulder arthroplasty (RSA) representing approximately 1% of total complications. The purpose of this study is to identify patients who underwent RSA and were revised because of loosening of the humeral component, identify patients who are at increased risk, and report on their surgical outcomes. A retrospective review of all patients who received a primary RSA or revision RSA (rRSA) by a single surgeon from 2002-2021 identified a total of 1591 primary RSA and 751 rRSA procedures. These procedures were then organized based on indication for surgery. Further analysis was performed to identify RSAs that were subsequently revised because of aseptic loosening of the humeral component. A total of 41 surgeries met the inclusion criterion for the study, which was any RSA or rRSA that was revised because of loosening of the humeral component. Exclusion criterion was revision for a reason other than humeral loosening, neurogenic arthritis, or revision for loosening that was not originally implanted by the senior author (9 surgeries). Ultimately, 32 surgeries met criteria for further analysis. These 32 surgeries were organized by indication for preceding RSA or rRSA and were assessed for an association between indication for RSA or rRSA and eventual revision for humeral loosening. Additionally, these procedures were compared to a "control cohort" of procedures that were not revised and that had minimum 2 years' follow-up. To assess outcomes for these patients, pre- and postoperative Simple Shoulder Test, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and ranges of motion were compared. Twenty procedures had sufficient data for outcomes analysis and were followed for an average of 54 months (range: 24-132 months). In primary RSAs, procedures performed for fracture or fracture sequelae were associated with revision for humeral-sided loosening (P =.009). In rRSAs, procedures performed for failed hemiarthroplasty for CTA were associated with rerevision for humeral-sided loosening (P =.009). Nine percent of patients revised for humeral loosening required rerevision for recurrent humeral loosening. Analysis of patients with 2-year clinical follow-up for humeral-sided loosening showed improvement in ASES pain (P =.014), ASES function (P =.042), and total ASES scores (P =.007). Humeral loosening is rare in RSA. In our cohort, 0.7% of the primary RSAs performed and 2.8% of the rRSAs performed were eventually revised for humeral loosening. Revisions of RSA for humeral loosening yield modest clinical improvements. Rerevision for humeral loosening was 6.3% of patients in our cohort. [ABSTRACT FROM AUTHOR]

The purpose of this study was to (1) evaluate whether improved external rotation (ER) in patients with preoperative ER <0° impacts their clinical outcomes following reverse shoulder arthroplasty (RSA) for rotator cuff (RC) pathology and (2) describe the differences in preoperative factors and postoperative outcomes in this patient population. Our hypothesis was that clinical outcomes would not be affected by improvement in ER using a lateralized glenosphere design. We retrospectively reviewed 55 patients with preoperative ER <0° who underwent primary RSA for RC pathology with lateralized glenosphere. Pre- and postoperative physician-reported ER was blindly measured using a videographic review of patients externally rotating their arm at the side. Patients were evaluated using 5 different patient-reported outcome score thresholds, measured at 12 months postoperatively: (1) minimal clinically important difference (MCID) for American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores (ie, ≥20-point increase); (2) MCID for Simple Shoulder Test (SST) scores (≥2.4-point increase); (3) visual analog scale (VAS) for pain score >0; (4) mean ASES score (≥75); and (5) mean SST score (≥6.8), each of which was used to stratify the patients into 2 groups—greater than or equal to vs. less than the threshold. This resulted in 5 different evaluations comparing the 2 groups for any difference in postoperative ER or preoperative factors, including Hamada and Goutallier scores. Regardless of the measured outcome, there was no difference in either postoperative physician- or patient-reported ER between patients who achieved scores higher or lower than the thresholds. Both Hamada and Goutallier score distributions were not different between groups across all the evaluated outcomes. Patients who achieved the MCID for ASES had worse preoperative VAS pain (7 vs. 4, P =.011) and SST (1 vs. 3, P =.020) scores. Across all outcome thresholds, except MCID for SST, pain reduction (ΔVAS) was significantly more pronounced in patients exceeding the thresholds. Improved forward flexion rather than ER was observed in those who achieved the ASES (160° vs. 80°, P =.020) and SST MCIDs (150° vs. 90°, P =.037). Finally, patients who exceeded the thresholds experienced higher satisfaction rates. Improvement in ER does not appear to impact patient-reported outcome measures, including ASES and SST in patients with preoperative ER <0° undergoing RSA with a lateralized glenosphere. Patients with more severe pain and worse function at baseline experience less postoperative pain and clinically significant improvement in their reported outcomes. [ABSTRACT FROM AUTHOR]

The purpose was to evaluate the relationship between acromial morphology and the location of acromial fractures following reverse shoulder arthroplasty and determine whether fracture location and displacement impact clinical outcomes. We performed a multicenter retrospective review of reverse shoulder arthroplasties complicated by acromial fractures. Radiographs were compared to determine the differences in acromial morphology, as well as fracture orientation and pattern, between patients with Levy type I (n = 17) and Levy type II (n = 25) fractures. Patients with a minimum of 2 years' follow-up were selected to examine the association between clinical outcomes and fracture location and displacement. Twenty-two patients were stratified based on whether they achieved the minimal clinically important difference (MCID) in the American Shoulder and Elbow Surgeons score (20 points). The groups were then compared regarding fracture location and displacement using measurements such as the acromiohumeral distance. The Levy type I group had a higher acromial slope than the Levy type II group (127° vs. 117°, P <.001). Levy type I fractures had a transverse pattern occurring in the coronal plane, whereas Levy type II fractures had an oblique pattern occurring in the sagittal plane (P <.001). At final follow-up, 12 of 22 patients (55%) achieved the MCID. Those who did not achieve the MCID had more displaced fractures including a lower acromiohumeral distance (8 mm vs. 20 mm, P =.007). There was no difference in the distribution of Levy type I and type II fractures based on the MCID cutoff (P =.093). An increased acromial slope is associated with transverse fractures in the Levy I region, whereas a lower acromial slope is associated with oblique fractures in the Levy II region. Overall, 55% of patients achieved the MCID at mid-term follow-up. The outcomes of those who did not achieve the MCID became worse postoperatively, and this was associated with increased fracture displacement. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the relationship between preoperative subscapularis (SSc) status as well as radiographic factors with internal rotation (IR) following reverse shoulder arthroplasty (RSA). Our hypothesis was that increased glenosphere lateralization and SSc insertion lateralization and the absence of a preoperative SSc tear would be associated with improved postoperative IR (IR F). A retrospective review was performed of primary RSAs (n = 132) by a single surgeon using a 135° inlay prosthesis. Range of motion including forward flexion (FF F), external rotation (ER F) and IR F were evaluated at one year postoperative. IR F was divided into high (≥L4) and low (≤L4) groups. Preoperative SSc status, glenosphere size, and postoperative positions of the glenosphere and humerus were assessed. Novel radiographic factors were used to assess lateralization including the lesser tuberosity scapula (LTS) and lateral glenosphere scapula (LGS) ratios. Only 32% of patients achieved IR F ≥ L4 postoperatively. Patients who achieved high IR F had a lower incidence of preoperative SSc tear compared to those who had an IR F < L4 (9% vs. 47%; P =.002). Higher LTS and LGS ratios were associated with improved IR F (P <.001). The chance of having IR F ≥ L4 increased by 86% (P =.049) and by 62% (P =.038) for every 0.1 increase in LGS ratio and LTS ratios, respectively. With a 135° inlay prosthesis design, an intact SSc preoperatively, as well as increased lateralization parameters, LTS and LGS ratios are associated with increased postoperative IR following RSA. Level III; Retrospective Case-control Comparative Study [ABSTRACT FROM AUTHOR]

Current practices may aim to blunt rather than understand postoperative pain. Perhaps the most common serious complication of arthroscopic rotator cuff repair (ARCR) is persistence of opiate medication intake. Patients still receive upwards of 80 oxycodone 5 mg pills, or 600 morphine milligram equivalents (MMEs), leading more than 20% of opioid-naïve subjects to continue to fill opioid prescriptions beyond 180 days after surgery. Developing evidence-based guidelines for narcotic prescription after ARCR presents an opportunity for orthopedic surgeons to address the opioid epidemic. The purpose of this study was (1) to prospectively determine the requirements for opiate medications after ARCR, and (2) to create an evidence-based guideline for postoperative prescription, in contrast to the anecdotal or expert panel recommendations that currently exist. We further investigated whether a liposomal bupivacaine (LB) interscalene never block (ISNB) would reduce pain and opiate consumption compared with standard bupivacaine ISNB (control) for ARCR. The study enrolled 100 patients who underwent primary ARCR surgery. Patients were provided with postoperative "pain journals" to document their daily pain on a numerical rating scale, satisfaction with pain management using the Likert scale, and track their daily oxycodone 5 mg pill consumption during the 14-day postoperative period. Enrolled patients were further randomized to receiving an LB (experimental) or standard bupivacaine (control) ISNB. A total of 77% of all patients required fewer than 15 pills postoperatively. The LB group consumed an average of 1.7 fewer pills (13.0 MMEs) on postoperative day (POD) 1 (P =.02) and reported statistically lower pain during PODs 1 and 2 (P =.01 and P =.006), as well as cumulatively throughout the study period (P =.03). In addition, LB patients remained opioid-free at a higher rate (44% vs. 15% in controls, P =.03). With a multimodal approach, the majority of patients undergoing ARCR can manage postoperative pain with 15 or fewer oxycodone 5 mg tablets (112.5 MMEs) and maintain a high degree of satisfaction. The addition of an LB ISNB may further reduce the consumption of postoperative narcotics compared with a standard ISNB. This study provides evidence that may be used for surgeon guidelines in the effort to reduce opioid prescriptions after ARCR. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the effects of lateralization and distalization on scapular spine fracture (SSF) after reverse shoulder arthroplasty (RSA). The hypothesis was that postoperative distalization would increase the risk of SSF, whereas lateralization would not. A multicenter retrospective review was performed at a minimum of 1 year postoperatively on primary RSAs with 3 different implants, 2 with an inlay design (n = 342) and 1 with an onlay design (n = 84). Functional outcome, range of motion, stem design, and radiographic measurements, including acromiohumeral distance and lateralization, were compared between groups with and without fracture. The incidence of SSF in the onlay group (11.9%) was significantly higher compared with the inlay group (4.7%; P =.043). Postoperative acromiohumeral distance was approximately 4 mm higher in the SSF group (37.5 mm) compared with the control group (33.7 mm; P =.042), whereas lateralization was similar between the 2 groups (52.8 mm vs. 53.9 mm; P =.362). Higher return to activity (92.1% vs. 71.4%; P <.001) as well as postoperative forward flexion was observed in the group without fracture (135° vs. 120°; P =.009). Increased postoperative distalization is associated with an increased risk of SSF after RSA. An onlay stem resulted in a 10 mm increase in distalization compared with an inlay stem, and a 2.5 times increased risk of SSF. Lateralization, however, does not appear to increase the risk of SSF. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the functional outcomes and humeral stress shielding of a reverse shoulder arthroplasty (RSA) placed with either cement or press-fit fixation. The hypothesis was that there would be no difference in functional outcomes or stress shielding. We performed a multicenter retrospective review of primary RSAs performed with standard-length stems. The stems were identical in geometry and coating with the only variable being whether the stems were secured with cement or by a press-fit technique. The functional outcomes and radiographs of 93 press-fit stems and 26 cemented stems were reviewed at a minimum of 2 years postoperatively. Significant improvements were noted in all ranges of motion and functional outcomes from baseline (P <.001), but no difference was found between the groups (P >.05). Calcar osteolysis was seen in 43% of press-fit and 58% of cemented stems (P =.266). Proximal lateral stress shielding was more common in the press-fit group (68%) than in the cemented group (25%) (P =.045). Adaptive changes were considered low in 97% of press-fit stems, and there were no cases of tuberosity resorption. No evidence of loosening or humeral component shift was noted in either group. At short-term follow-up, no differences in functional outcomes or stem loosening were found between press-fit fixation and cemented fixation of an RSA humeral stem. Proximal stress shielding was more common with press-fit fixation with the stem in this study, but the overall changes were considered low in 97% of cases. Further study is needed to evaluate the mid- to long-term differences regarding stress shielding. [ABSTRACT FROM AUTHOR]