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As the volume of shoulder arthroplasty procedures performed in the United States continues to increase, the predicted number of revision shoulder arthroplasties grows even higher. Conversion of failed shoulder arthroplasty to reverse total shoulder arthroplasty has become common. Many commercially available shoulder arthroplasty systems now offer a platform humeral stem that is used for both anatomic shoulder arthroplasty and reverse total shoulder arthroplasty. This study investigated whether retaining the humeral stem offers advantages over revising the humeral stem in conversion of failed shoulder arthroplasty to reverse total shoulder arthroplasty. The study included 26 patients (mean age, 68.46 years) with failed shoulder arthroplasty who underwent conversion to reverse total shoulder arthroplasty with a minimum 2-year follow-up (mean, 34.38 months). Patients who had retention of the humeral stem were compared with those who had stem revision. Humeral stem retention was associated with a significantly shorter operative time (178.92 vs 237 minutes, P =.02). Decreases in blood loss, complications, and length of hospitalization were observed, but the differences were not statistically significant. Minimal differences were observed for patient-reported outcomes. Of patients undergoing humeral stem removal, 21.4% had an intraoperative humeral shaft or tuberosity fracture compared with none in the stem retention group. Humeral stem retention was associated with decreased operative time compared with humeral stem revision in the conversion of failed shoulder arthroplasty to reverse total shoulder arthroplasty. The use of a platform shoulder arthroplasty system may benefit patients with failed shoulder arthroplasty undergoing conversion to reverse total shoulder arthroplasty by avoiding humeral stem revision. [ Orthopedics. 2015; 38(9):e773–e779.]

The beach chair position is commonly used in both arthroscopic and open shoulder procedures. There has been recent concern that beach chair positioning may be an independent risk factor for intraoperative cerebrovascular insult, especially in concert with hypotensive anesthesia. We attempted to quantify the prevalence of intraoperative cerebrovascular events during shoulder surgery in the beach chair position. Two hundred and eighty-seven members of the American Shoulder and Elbow Surgeons (ASES) Society were e-mailed surveys, and 93 (32%) responded. The majority of these surgeons average300 shoulder cases annually. Most of these cases are arthroscopic, and patient position is primarily beach chair. The total number of beach chair-position surgeries was estimated between 173,370 and 209,628, and lateral decubitus-position surgeries were estimated between 64,597 and 100,855. The overall rate of intraoperative cerebrovascular event was 0.00291% (8/274,225). All cerebrovascular events were associated with surgeries in the beach chair position. The rate in the beach chair position ranged from 0.00382% (8/209,628) to 0.00461% (8/173,370). If reported primary patient position was usedor = 75% of the time, no significant difference in observed cerebrovascular event rates was found between positions (P=.051-.0233). In relation to orthopedic procedures performed in the supine position, beach chair positioning does not appear to increase the risk of intraoperative cerebrovascular event.

The beach chair position is commonly used in both arthroscopic and open shoulder procedures. There has been recent concern that beach chair positioning may be an independent risk factor for intraoperative cerebrovascular insult, especially in concert with hypotensive anesthesia. We attempted to quantify the prevalence of intraoperative cerebrovascular events during shoulder surgery in the beach chair position. Two hundred and eighty-seven members of the American Shoulder and Elbow Surgeons (ASES) Society were e-mailed surveys, and 93 (32%) responded. The majority of these surgeons average >300 shoulder cases annually. Most of these cases are arthroscopic, and patient position is primarily beach chair. The total number of beach chair-position surgeries was estimated between 173,370 and 209,628, and lateral decubitus-position surgeries were estimated between 64,597 and 100,855. The overall rate of intraoperative cerebrovascular event was 0.00291% (8/274,225). All cerebrovascular events were associated with surgeries in the beach chair position. The rate in the beach chair position ranged from 0.00382% (8/209,628) to 0.00461% (8/173,370). If reported primary patient position was used > or = 75% of the time, no significant difference in observed cerebrovascular event rates was found between positions (P=.051-.0233). In relation to orthopedic procedures performed in the supine position, beach chair positioning does not appear to increase the risk of intraoperative cerebrovascular event.

This biomechanical study evaluates the effect of varus malalalignment on knees with a chondral defect, both pre- and post-medial meniscectomy. Eight fresh-frozen cadaveric knees were first loaded physiologically. The knees were next loaded in increasing increments of varus. This loading cycle then was repeated after a chondral defect had been created, both pre- and post-medial meniscectomy. We found that a relatively small degree of varus malalignment caused a dramatic alteration in articular surface contact pressure and medial compartment loading, especially in the presence of chondral damage and/or medial meniscectomy. These findings may have important implications relating to the treatment of younger individuals with varus knees who have sustained meniscal and/or chondral damage.