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The purpose of this study is to report the minimum 5-year clinical and radiographic outcomes of patients undergoing anatomic total shoulder arthroplasty (aTSA) with a posteriorly augmented glenoid component. Thirty-five shoulders with minimum 5-year follow-up underwent aTSA using a posteriorly augmented glenoid component for the treatment of glenohumeral osteoarthritis with posterior glenoid bone loss. Clinical outcomes included range of motion, visual analog scale (VAS) for pain, and patient-reported outcomes scores. Radiographs and computed tomography scans were obtained to assess glenoid morphology, retroversion, and central peg osseous integration via Wirth score, Lazarus scores, and Yian scores. Postoperative outcomes were measured at minimum 2- and 5-year follow-up. Kaplan-Meier survival analysis was calculated. Two patients experienced prosthetic instability requiring revision, leaving 33 shoulders with an average follow-up of 6.6 years. Average preoperative glenoid retroversion was 21.6°. A significant improvement in pain, range of motion, and patient-reported outcomes score was noted at minimum 2- and 5-year follow-up. In addition, VAS pain, American Shoulder and Elbow Surgeons, and Quick Disabilities of the Arm, Shoulder, and Hand scores improved between minimum 2- and 5-year follow-up. The average Lazarus and Yian scores at final follow-up were 0.73 and 2.6, respectively. There was an increase in Lazarus score and a decrease in Wirth score between 2- and 5-year follow-up. A significant correlation was identified between VAS pain scores and both Lazarus and Wirth scores. Survivorship free from revision was 92% at 8.8 years postoperatively. Midterm results of aTSA with a posteriorly augmented, stepped glenoid component demonstrate sustained improvements in clinical outcomes with low rates of radiographic loosening. Continued improvement in pain and function, as well as a minor progression of radiographic osteolysis, may be expected between 2- and 5-year follow-up. In addition, the severity of radiographic loosening correlates with subjective pain levels. [ABSTRACT FROM AUTHOR]

Congenitally corrected transposition of the great arteries (ccTGA) is a rare cardiac anomaly. The management strategy historically consisted of physiologic repair, leaving the morphologic right ventricle to support the systemic circulation. More recently, anatomic repair has been implemented to bring the left ventricle into the systemic circulation. Uncertainty persists about which repair strategy has the best outcome. This meta-analysis aimed to summarize the long-term mortality risks following anatomic and physiologic repair of ccTGA. PubMed, Embase, and the Cochrane Database were searched. Data were extracted using prespecified data forms. The primary outcome was the composite risk of all-cause mortality or heart transplantation during hospitalization and at 1, 5, and 10 years of follow-up. Secondary outcomes included reintervention risk. Forty-seven studies totaling 2,844 patients were included. The incidence risk of mortality at 10 years was 11.7% (95% CI: 8.5%-15.3%) and 17.4% (95% CI: 12.4%-23.0%) in the anatomic and physiologic repair groups, respectively. The incidence risk of reintervention at 10 years was 24.5% (95% CI: 19.2%-30.1%) and 30.3% (95% CI: 23.5%-37.6%), respectively. The primary outcome was significantly lower at 10 years in anatomically repaired patients who had surgery at <5 years of age and who had preoperative pulmonary artery banding (P heterogeneity < 0.01). Anatomic repair of ccTGA patients results in higher overall and reintervention-free survival compared to physiologic repair. Specifically, patients who had anatomic repair at <5 years of age or who had preoperative pulmonary artery banding have better survival. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine whether the iliac crests are truly at the level of L4 to L5, accounting for patient demographic and anthropometric characteristics. Methods: We measured the umbilicus and iliac crests relative to the lumbar spine using computed tomography of patients without spinal pathology, accounting for the influences of patient height, weight, body mass index (BMI), sex, race, and ethnicity. Results: A total of 834 patients (391 men and 443 women) were reviewed. The location of the umbilicus relative to the lumbar spine demonstrated a unimodal distribution pattern clustered at L4, while the iliac crests were most frequently located from L4 to L5. Iliac crests were located above the L4 to L5 disc space 26.5% of the time. Iliac crests were located at the L4 to L5 disc space 29.8% of the time. No correlations were observed between the umbilicus and iliac crests with patient height, weight, or BMI. There was no difference in the location of the umbilicus with respect to patient sex, race, and ethnicity. The locations of the iliac crests were cephalad in women compared with men and in Hispanics compared with African American, Caucasian, and Asian patients. Conclusions: The iliac crests were located above the level of the L4 to L5 disc space approximately 26% of the time. The umbilicus is most frequently at the level of the L4 vertebral body. Patient height, weight, and BMI do not influence the location of the umbilicus or the iliac crests relative to the lumbar spine. Patient sex and ethnicity influence the location of the iliac crests but not the umbilicus relative to the lumbar spine. Clinical Relevance: Modern neurosurgical techniques require clearance of the iliac crests during anterior and anterolateral approaches. Understanding the level of the iliac crests is crucial in planning for transpsoas fusion approaches. [ABSTRACT FROM AUTHOR]

Anatomic total shoulder arthroplasty is one of the recommended surgical treatments for severe glenohumeral osteoarthritis, providing good pain relief and function. Aseptic loosening of the glenoid component, however, is a major cause for revision. Hybrid components have been introduced, combining traditional cemented fixation with porous titanium bone ingrowth to improve fixation. The purpose of this study was to report our midterm to longterm experience using such a component, including clinical outcomes and implant survival. We reviewed all patients who were operated for primary osteoarthritis during the period 2011-19, leaving a minimum of 2-year follow-up. The severity of the osteoarthritis was graded using Samilson-Prieto score, while glenoid morphology was graded using the modified Walch classification. Clinical outcomes included Western Ontario Osteoarthritis of the Shoulder (WOOS) index, EQ-5D-5L, and Constant-Murley score. Postoperative radiographs were analyzed for radiolucent lines. Patient records were studied for complications including revisions. Supplementary data for revision and outcome were obtained from the Danish Shoulder Arthroplasty Registry. Kaplan-Meier estimates for implant survival were calculated. A total of 256 arthroplasties in 224 patients were included (mean age: 69 years ± 9 years, 149 females). 81% of cases were graded radiographically as severe osteoarthritis, according to Samilson-Prieto. Walch type B1 was most commonly followed by B2 (29% and 28% respectively). The mean follow-up time was 49 months (range 24-127). The response rate for patient reported outcomes was 91%. The median WOOS index was 94% (81%-99%), the median EQ-5D-5L was 0.87 (0.69-0.95), and the mean Constant-Murley score was 75 (SD 17.7). 13 cases (6%) had a WOOS index below 50%. 8.2% had complications related to surgery. A radiolucent line had developed around the central post in six cases and at the bone-cement interface in three cases at follow-up. Six cases had been revised (2.3%); three due to aseptic loosening of the glenoid. The 10-year survival estimate was 95.6 % (95% CI: 87.9%-98.5%). Anatomic total shoulder arthroplasty with hybrid glenoid fixation provides excellent clinical outcome with a low complication rate in patients, with primary glenohumeral osteoarthritis. The 10-year survival rate is high and comparable to that reported for the best- performing all-polyethylene components. Longer observation is needed to see if hybrid fixation will outperform standard all-cemented components. [ABSTRACT FROM AUTHOR]

The annual utilization of reverse total shoulder arthroplasty (RTSA) and anatomic total shoulder arthroplasty (ATSA) has grown exponentially, in part due to the expanded indications of RTSA. This evolution in shoulder arthroplasty prompts the need to evaluate outcomes between ATSA and RTSA. However, many other studies comparing outcomes between ATSA and RTSA lacked a large nationally-represented sample, a matched cohort analysis, or both. In this study, we compare outcomes between patients undergoing ATSA or RTSA in a large matched-cohort analysis. Patients undergoing RTSA or ATSA from the National Inpatient Sample database between 2016 and 2019 were identified. Groups were propensity-matched based on demographics and comorbidities. We compared medical and surgical complications, length of stay, and total hospital charges. T-tests and chi-square tests were performed for continuous and categorical variables, respectively. Odds ratios were calculated as a ratio between RTSA and ATSA groups. Following matching, there were 38,782 patients in the ATSA group and 35,461 patients in the RTSA group. The RTSA group had higher odds of acute renal failure (OR 1.35), blood loss anemia (OR 1.39), and pneumonia (OR 1.19). There were no differences for myocardial infarction, pulmonary embolism, deep venous thrombosis, mortality, periprosthetic fracture, or dislocation. The RTSA group had higher odds of periprosthetic mechanical complication (OR 1.92), but lower odds of periprosthetic joint infection (OR 0.65). The mean length of stay and total hospital charges were both higher in the RTSA group (p < 0.001). We found patients undergoing RTSA are at higher odds of inpatient medical complications, including acute renal failure and acute blood loss anemia. RTSA is associated with higher odds of short-term periprosthetic mechanical complications. [ABSTRACT FROM AUTHOR]

Objective: To explore the feasibility of single incision C7 nerve transfer surgery through the subarachnoid pathway on the healthy side through anatomical research. Method: Four fresh frozen cadaver specimens were used for the study. Observe and measure the length of C7 nerve root fibers. Divide the front root into 3 bundles and the rear root into 5 bundles. Result: The C7 nerve has a filamentous structure, arranged symmetrically on both sides, and the length of the root fibers gradually shortens from top to bottom. The length of the left anterior root decreased from (12.25 ± 0.68) mm to (9.75 ± 1.40) mm, the length of the right anterior root decreased from (12.95 ± 1.49) mm to (10.00 ± 2.00) mm, the length of the left posterior root decreased from (15.63 ± 1.55) mm to (12.38 ± 0.71) mm, and the length of the right posterior root decreased from (15.48 ± 1.37) mm to (12.30 ± 0.90) mm. The distance from the exit of the C7 nerve from the dura mater to the fusion site in 4 specimens was (10.98 ± 1.21) mm on the left and (10.98 ± 1.391) mm on the right. All four specimens have completed nerve bundle anastomosis. Conclusion: From an anatomical perspective, it is feasible to anastomose the healthy side C7 nerve with the affected side root fibers in the dorsal bundle of the spinal cord after cutting off the dura mater. [ABSTRACT FROM AUTHOR]

Background: Anatomic rectangular tunnel anterior cruciate ligament reconstruction (ART-ACLR) can mimic the fiber arrangement of the native ACL and restore normal knee biomechanics, compared with the conventional round tunnel ACLR. ART-ACLR using a bone–patellar tendon–bone (BPTB) graft can provide satisfactory clinical outcomes; however, some issues such as secondary ACL injury and donor-site morbidity, including postoperative anterior knee pain (AKP), remain to be solved. Due to these issues, quadriceps tendon–bone (QTB) grafts have recently become more popular. Purpose: To compare the 2-year clinical outcomes of ART-ACLR with BPTB and QTB autografts. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 134 patients underwent primary ART-ACLR with BPTB (n = 70) or QTB (n = 64). All patients had a minimum follow-up period of 2 years postoperatively. Outcome evaluations included the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), side-to-side differences (SSDs) with the KT-1000 knee arthrometer, rate of secondary ACL injury, and incidence of AKP. Results: Regarding age, sex, height, weight,and concomitant procedures, there were no significant differences between the 2 groups. All clinical scores significantly improved from preoperatively to 6 months postoperatively and further increased throughout the 2-year postoperative period in both groups. The IKDC and all subscales of the KOOS, except Sport and Recreation, were equivalent between the BPTB and QTB groups at each postoperative time point. There were no significant differences in the SSD value of KT-1000 arthrometer between the 2 groups. The rates of secondary ACL injury were 10.0% on the ipsilateral side and 2.9% on the contralateral side in the BPTB group and 3.1% on the ipsilateral side and 4.7% on the contralateral side in the QTB group, with no significant difference between both groups. The incidence of AKP was 17.1% and 4.9% in the BPTB group and QTB group, respectively, with significance of P =.02). Conclusion: The clinical scores, SSD value of the KT-1000 arthrometer, and secondary ACL injury rates were equivalent between the BPTB and QTB groups. However, the incidence of AKP was significantly lower in the QTB group, suggesting that QTB could be a favorable graft for ACLR. [ABSTRACT FROM AUTHOR]

Background: Tendon transfers in conjunction with reverse total shoulder arthroplasty can significantly improve functional outcomes in patients with glenohumeral arthritis and irreparable rotator cuff deficiency. There have been multiple promising new techniques described within the last 20 years that shoulder surgeons should become familiar with. Methods: The authors reviewed the literature on tendon transfers in the setting of reverse total shoulder arthroplasty. Procedures to restore various shoulder functions were described including surgical anatomy, techniques, pearls and pitfalls, and photos. Results: Subscapularis insufficiency can be reconstructed with a pectoralis major transfer or latissimus dorsi transfer, with the latter having better clinical outcomes and a more anatomic line of pull. Posterosuperior rotator cuff deficiency can be reconstructed with a latissimus transfer (L’Episcopo transfer) or lower trapezius transfer, with the latter proving superior in biomechanical and short-term studies. Deltoid deficiency can be reconstructed with a pedicled upper pectoralis major transfer. Massive proximal humerus bone loss can be reconstructed with an allograft-prosthetic composite, and any of the aforementioned transfers can be utilized in this setting as well. Conclusion: Tendon transfers in conjunction with reverse shoulder arthroplasty can significantly improve functional outcomes in patients with glenohumeral arthritis and irreparable rotator cuff deficiency. There have been multiple promising new techniques described within the last 20 years that shoulder surgeons should become familiar with.

Background: The rising prominence of artificial intelligence in healthcare has revolutionized patient access to medical information. This cross-sectional study sought to assess if ChatGPT could satisfactorily address common patient questions about total shoulder arthroplasty (TSA). Methods: Ten commonly encountered questions in TSA practice were selected and posed to ChatGPT. Each response was assessed for accuracy and clarity using the Mika et al. scoring system, which ranges from "excellent response not requiring clarification" to "unsatisfactory response requiring substantial clarification," and a modified DISCERN score. The readability was further evaluated using the Flesch Reading Ease Score and the Flesch-Kincaid Grade Level. Results: The mean Mika et al. score was 2.93, corresponding to an overall subjective rating of "satisfactory but requiring moderate clarification." The mean DISCERN score was 46.60, which is considered "fair." The readability analysis suggested that the responses were at a college-graduate level, higher than the recommended level for patient educational materials. Discussion: Our results suggest that ChatGPT has the potential to supplement the collaborative decision-making process between patients and experienced orthopedic surgeons for TSA-related inquiries. Ultimately, while tools like ChatGPT can enhance traditional patient education methods, they should not replace direct consultations with medical professionals. [ABSTRACT FROM AUTHOR]

Background: Glenoid component positioning is an important and challenging aspect of total shoulder arthroplasty. The use of freehand technique with standard instrumentation or preoperative planning based on 2-dimensional computed tomography (CT) scans provides an opportunity for improvement in terms of component accuracy, precision, and deformity correction. These techniques have produced varying outcomes. Methods: Preoperative planning software (PPS), patient specific instrumentation (PSI), and intraoperative navigation (NAV) have been developed to improve the accuracy of implant placement and deformity correction with the ultimate goals of improved patient outcomes and implant longevity. Literature search was conducted on published and available studies comparing the accuracy of glenoid component placement and improvements in surgical and patient outcomes amongst the aforementioned techniques. Results: PPS, PSI, and NAV have demonstrated improved accuracy over freehand techniques with standard instrumentation. However, data demonstrating the clinical benefit and cost effectiveness of these new technologies are lacking. Discussion: In this paper, we reviewed the evidence available to answer the question of whether or not advanced shoulder arthroplasty technologies have been beneficial and reviewed future technologies in development such as virtual/mixed-reality and robotic assisted shoulder surgery. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background: Indications for reverse total shoulder arthroplasty(rTSA) continue to expand making it challenging to predict whether patients will benefit more from anatomic TSA(aTSA) or rTSA. The purpose of this study was to determine which factors differ between aTSA and rTSA patients that achieve meaningful outcomes and may influence surgical indication. Methods: Random Forest dimensionality reduction was applied to reduce 23 features into a model optimizing substantial clinical benefit (SCB) prediction of the American Shoulder and Elbow Surgeon score using 1117 consecutive patients with 2-year follow up. Features were compared between aTSA patients stratified by SCB achievement and subsequently with rTSA SCB achievers. Results: Eight combined features optimized prediction (accuracy = 87.1%, kappa = 0.73): (1) age, (2) body mass index (BMI), (3) sex, (4) history of rheumatic disease, (5) humeral head subluxation (HH) on computed tomography (CT), (6) HH–acromion distance on X-ray, (7) glenoid retroversion on CT, and (8) Walch classification on CT. A higher proportion of males (65.6% vs. 54.9%, p = 0.022), Walch B-C glenoid morphologies (49.5% vs. 37.9%, p < 0.001), and greater BMI (30.1 vs. 26.5 kg/m2, p = 0.038) were observed in aTSA nonachievers compared with aTSA achievers, while aTSA nonachievers were statistically similar to rTSA achievers. Discussion: Patients with glenohumeral osteoarthritis and intact rotator cuffs that have a BMI > 30 kg/m2 and exhibit Walch B-C glenoids may be less likely to achieve the SCB following aTSA and should be considered for rTSA. [ABSTRACT FROM AUTHOR]

Introduction: The normative relationship between lumbar intervertebral disc space height (DSH) and neuroforaminal dimensions (NFD) has yet to be defined. Research question: The purpose of this study was to investigate the relationship between lumbar DSH and NFD using computed tomography (CT), accounting for influences of patient demographic and anthropometric characteristics. Materials and methods: We analyzed CT imaging of 350 female and 350 male patients. Anterior, middle, and posterior DSH were measured. NFD were defined as sagittal anterior-to-posterior (AP) width, axial AP width, foraminal height, and area. Statistical analyses were performed to assess associations among DSH, NFD, and patient height, weight, body mass index, sex, and ethnicity. Results: Irrespective of disc level, mean anterior, middle, and posterior DSH were 7.98 mm (n = 3500), 8.16 mm (n = 3500), and 4.09 mm (n = 3500). DSH measurements demonstrated increasing, linear trends moving caudally from L1-L2 to L5-S1, while NFD demonstrated a unimodal distribution pattern with largest NFD at L3-L4 and smallest NFD at L1-2 and L5-S1. Male patients demonstrated larger DSH compared to female patients from L1-S1. Asian patients demonstrated taller DSH across all levels L1-S1. Discussion and conclusion: This study describes 38,500 CT-based L1-S1 DSH and NFD in young patients without spinal pathology. DSH follows an increasing trend moving caudally from L1-S1, while NFD demonstrate a unimodal distribution clustered at L3-L4. NFD are not moderately or strongly associated with DSH. DSH is influenced by sex and ethnicity but is not moderately or strongly influenced by patient height, weight, and BMI.

Introduction: Reconstruction of the nipple-areola complex (NAC) is indicated when this member is amputated in mastectomies to ensure a more natural appearance to the reconstructed breast. It was first reported by Berson in 1946, but there are currently more than 60 different techniques, all described in the last 8 decades. Method: To construct the models, a female bust mannequin, foam sheet, mesh, scissors, Styrofoam glue, and sewing material were required. Once completed, the flap could be marked with a fine-needle brush, and the various techniques described in the literature could be practiced. The model was presented to the plastic surgeon supervising the Plastic Surgery League of the University of Fortaleza and was approved and recommended for low-cost simulation. Results: The interest of students in a theoretical class on NAC reconstruction techniques sparked interest in producing a synthetic training model, and due to its ease of practical handling and complete simulation, it was decided to use synthetic material, which allows training in the CV Flap technique. Conclusion: The synthetic model for the reconstruction of the nipple-areola complex can accurately simulate the steps of the real surgical procedure, in addition to providing benefits such as good accessibility and low production cost.

[Display omitted] [ABSTRACT FROM AUTHOR]

Background: Biomechanical research demonstrates increased subscapularis abduction range of motion (ROM) when the tendon’s upper two-thirds is repaired over-the-top of the center of rotation during reverse shoulder arthroplasty (RSA). This study compares the clinical outcomes of patients undergoing RSA with over-the-top subscapularis repair (OTTR) to patients without repair. Methods: We retrospectively reviewed 97 consecutive RSAs with either OTTR of the subscapularis (N = 75) or no repair (N = 22). Repair was attempted in all patients but not performed if the subscapularis could not be brought to the over-the-top position in 20° of external rotation (ER) and 30° of abduction. Improvements in ROM were compared to the minimal clinically important difference for RSA. Results: The mean follow-up was 3.8 ± 1.6 years. Demographics were similar between groups. Preoperatively, patients undergoing repair had greater ER when compared to those without repair (15 ± 16° vs. 5 ± 12°, P = .003). Postoperatively, patients undergoing repair had greater forward elevation (132 ± 21° vs. 126 ± 22°, P = .268) and abduction (114 ± 26° vs. 106 ± 23°, P = .193) with both exceeding the minimal clinically important difference (−2.9° and −1.9°, respectively); however, not statistically significant. Patients with repair were more frequently able to reach the small of their back postoperatively (65% vs. 21%, P = .006) but had less improvement in ER (13 ± 20° vs. 24 ± 20°, P = .028). Postoperative outcome scores, complications, and reoperations were similar between groups. Discussion: OTTR of the subscapularis in RSA had similar ROM and outcome scores compared to no repair, but a significantly larger proportion of patients with repair achieved functional internal rotation to the small of the back. ER limitations seen after conventional repair may also apply to this novel technique, but without a corresponding detrimental effect on forward elevation or abduction.

Background: As the population is aging and indications are expanding, shoulder arthroplasty is becoming more frequent, especially bilateral staged replacement. However, surgeons are hesitant to use bilateral reverse prostheses due to potential limitations on activities of daily living. Methods: This meta-analysis was conducted to compare bilateral anatomic to bilateral reverse shoulder implants. PubMed, Cochrane, and Google Scholar (pages 1–20) were searched until April 2023. The clinical outcomes consisted of postoperative functional scores (American Shoulder and Elbow Surgeons [ASES], Single Assessment Numeric Evaluation [SANE], Physical Component Score [PCS], Mental Component Score, and Simple Shoulder Test), pain, and range of motion (external rotation and forward elevation). Three studies were included in this meta-analysis. Results: Bilateral anatomic implants had better postoperative functional outcomes and range of motion, but no significant difference was seen in postoperative pain when compared to the reverse prosthesis. Better ASES score, SANE score, and PCS as well as better external rotation and forward elevation were seen in the bilateral anatomic shoulder replacement group, but no significant difference in pain levels was seen between the two groups. Conclusions: These results may be explained by the lower baseline seen in the reverse prosthesis group, which may be due to an older population and different indications. Nevertheless, more randomized controlled studies are needed to confirm these findings. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Shoulder stiffness following both primary anatomic and reverse total shoulder arthroplasty (TSA) is a potential complication that is likely underreported. The deleterious effects of postoperative stiffness following TSA and the burden placed on both the patient and the healthcare system have not been well studied. The purpose of this study is to determine the incidence of postoperative stiffness following primary TSA and analyze the effect it has on short-term outcomes up to 180 days following primary TSA. This was a retrospective, comparative cohort study. The Nationwide Readmissions Database was queried from 2010 to 2020 for patients who had undergone primary TSA using International Classification of Diseases Clinical Modification and Procedure Coding System codes. Patients were then separated into stiff and non-stiff cohorts. A one-to-one match was performed based on age, sex, and the Charlson comorbidity index. Statistical analyses included chi-square, sample t -tests, logistic, and linear regression. A total of 7792 subjects were included in the study. The overall incidence of postoperative stiffness was 1.8%. Patients with stiffness following primary TSA were 57% more likely to be readmitted within 180 days (odds ratio [OR] = 1.57) and had increased hospital costs by over $5000 (P <.001), but mortality rates were not increased. However, the odds of experiencing any medical complication or revision decreased by 52% and 76%, respectively, in the stiff group (OR = 0.48, and OR = 0.24, respectively). Postoperative stiffness was inversely predictive of prosthetic dislocation (OR = 0.03), loosening (OR = 0.03), and periprosthetic fracture (OR = 0.04). The incidence of postoperative stiffness following primary TSA was low at 1.8 %. These patients were found to be at increased risk for readmission within 180 days and incurred significantly higher hospital costs compared to the non-stiff cohort. However, postoperative stiffness did not increase the odds of experiencing increased medical complications, mechanical complications, mortality, or revision at 180 days. This information can help guide surgeons in discussion with and management of patients who develop stiffness following primary TSA. [ABSTRACT FROM AUTHOR]

Limitations of traditional stemmed anatomic total shoulder arthroplasty (aTSA) with a spherical head and onlay glenoid include 1) inaccurate replication of native nonspherical humeral head kinematics, 2) substantial bone resection, and 3) susceptibility to glenoid loosening. Our purpose was to examine the outcomes of stemless aTSA with a nonspherical head and inlay glenoid. Sixty patients (63 shoulders) with end-stage glenohumeral osteoarthritis were treated by a single surgeon. The study population was limited to 22 patients/25 shoulders (13 male, 12 female; mean age 65.6 years) with 2-year minimum follow-up (mean 51.8 months) subdivided into 2 groups by age. The young group included 5 patients/5 shoulders (3 male, 2 female; mean age 52.2 years; mean follow-up 62.4 months), while the elderly group included 17 patients/20 shoulders (10 male, 10 female; mean age 68.9 years; mean follow-up 49.2 months). At the final follow-up, patient satisfaction and complications were evaluated and the Constant-Murley, American Shoulder and Elbow Surgeons, and SF-36 scores were compared to preoperative values. First postoperative radiographs were compared to the final follow-up for signs of gross loosening, implant tilt, subsidence, and periprosthetic radiolucency. No humeral shaft fractures, infections, glenoid/humeral component loosening, radiolucencies, shoulder dislocations, or neurovascular complications were encountered. No reoperations or revisions were performed. The entire study population (25 shoulders) showed significant increases in the Constant score (47.4-82.8, P <.001), American Shoulder and Elbow Surgeons score (36.9-88.1, P <.001), and all components of the SF-36 score (P <.014) except general health perceptions (P =.490), role imitations (emotional) (P =.232), and mental health (P =.746), with a 95% patient satisfaction rate. There were no significant differences between the young and elderly groups in any outcomes (P >.107). Our results suggest that stemless aTSA performed with a nonspherical humeral head and inlay glenoid is a safe and effective treatment for glenohumeral osteoarthritis in both young and elderly patients. However, longer term studies with larger patient populations will be required for corroboration. [ABSTRACT FROM AUTHOR]

Elective shoulder arthroplasty is commonly performed in elderly patients with end-stage arthritis. However, a significant number of young patients also undergo this procedure. The surgical outcomes for young patients are not extensively studied compared to older patients. This study aimed to assess the short-term outcomes of anatomic total shoulder arthroplasty (aTSA) in patients aged 18-50 years with primary glenohumeral arthritis and compare them to patients aged 65-75 years. A retrospective review was conducted on aTSA procedures performed for glenohumeral arthritis at a single hospital system between January 1st, 2005, to September 15th, 2023. Patients aged 18-50 years with a minimum 2-years of follow-up were compared to a cohort of patients aged 65-75 years. Data included range of motion and patient-reported outcome measures (Disabilities of the Arm, Shoulder, and Hand [DASH], American Shoulder and Elbow Surgeons, Simple Shoulder [SS], and Visual Analog Scale pain scores), which were compared between the two groups preoperatively and at final follow-up. The younger group included 19 shoulders with a mean age of 44.2 ± 6.4 years at the time of surgery and a mean follow-up of 3.9 ± 1.9 years. The older group included 27 shoulders with a mean age of 70.3 ± 3.0 years at the time of surgery and a mean follow-up of 2.5 ± 0.8 years. The younger group failed to show improvements in all range of motion parameters at final follow-up, while the older group demonstrated improvement in range of motion for all measures. The older group had superior forward elevation and abduction at final follow-up. Both groups exhibited improvements in pain and shoulder function at final follow-up. The younger group did not show significant improvement in DASH scores at final follow-up. Preoperatively, the older group had significantly better DASH and SS scores compared to the younger group. The older group had significantly better DASH, American Shoulder and Elbow Surgeons, SS, and pain scores at final follow-up compared to the younger group. Both groups experienced significant improvement in pain and subjective outcome measures after a 2-year follow-up. Despite this, the younger cohort had worse shoulder range of motion outcomes and lower function and higher pain scores than the older cohort. Nonetheless, aTSA remains a valuable treatment option for young patients in the short-term. However, it is crucial to consider that younger patients may experience dissatisfaction and receive less pain relief compared to older patients, and these factors should be considered when determining the suitability of this treatment approach. [ABSTRACT FROM AUTHOR]

Anatomic total shoulder arthroplasty (aTSA) remains the gold-standard for management of end-stage glenohumeral arthritis. However, in the setting of failed hemiarthroplasty or aTSA, the appropriate utilization of revision to an anatomic vs. reverse TSA remains unknown. This study aims to assess the outcomes of revision to aTSA. All revision shoulder arthroplasty cases at a single institution by one of five fellowship-trained surgeons were reviewed. All aseptic revision cases where the revision construct was an aTSA were included. Attempts were made to contact each case for enrollment in the institution's shoulder registry and ascertain any cases requiring revision surgery. Patient-reported outcome measures: American Shoulder and Elbow Surgeons score, single assessment numeric evaluation, visual analog scale for pain, patient satisfaction, and a validated scale of patient-reported shoulder range-of-motion were collected. Twenty eight cases underwent revision aTSA between 2004 and 2019. The average age was 53.4 years (range: 23-66), 16 (57%) were male, and 14 (50%) were revised from a hemiarthroplasty while the remainder were revised from an aTSA. Seven (25%) cases required revision surgery at a mean 1.8 years. Three of these cases had been revised from hemiarthroplasty. Reasons for revision included: glenoid loosening (1), infection (1), rotator cuff failure (3), and persistent pain of nonspecific etiology (2). Ultimately, 6 (21%; 6/28) were revised to reverse TSA at a mean of 2 years (range: 1 month-5.7 years) postoperatively. Patients requiring further revision surgery were older (58.8 vs. 51.4 years; P =.06) than those not requiring further revision. Of the patients managed with lesser tuberosity osteotomy, the revision rate was 7.1% (1/14) compared to 42.9% (6/14) for the remainder of the cohort (P =.08). Of the 21 patients with retained aTSA, 15 (71%) provided clinical follow-up at an average of 4 years (range: 1-8). These patients had a mean American Shoulder and Elbow Surgeons score of 70.2 (range: 41-94), visual analog scale pain score of 2.8 (range: 0-6), single assessment numeric evaluation score of 52.1% (range: 14-92), and satisfaction of 73% (range: 1-100). The outcomes of revision shoulder arthroplasty to an aTSA construct are varied. While in the appropriately indicated young patient high-quality results can be achieved, there is a high revision rate and highly variable patient-reported outcomes. Surgeons should be selective when recommending revision to an aTSA. Further study is needed to better predict successful outcomes in this patient population. [ABSTRACT FROM AUTHOR]

Introduction: A significant proportion of patients remain dissatisfied following total knee arthroplasty (TKA) surgery. Reasons for this are unclear. Contemporary implants seek to mirror innate anatomy. Such innovations are necessarily subject to scrutiny to validate their use. The Zimmer-Biomet Persona® Personalized Knee system is such an anatomic TKA. This work seeks to establish medium term survival data and patient reported outcomes for this implant. Methods: This was a cohort study of prospectively collected data on all patients undergoing Persona TKA at our institution. Patients were managed using a standardised protocol for intra- and post-operative care. Survivorship data were collected using our National Joint Registry and corroborated with local data. Range of motion, Oxford Knee Score (OKS) and patient satisfaction were recorded at six weeks and one year post-operatively. Hip-knee-ankle radiographs were used to record pre- and post-operative alignment. Results: Data were collected for 749 knees in 679 patients. Overall survivorship was 99.0% at a mean 5.35 years, with seven patients undergoing revision surgery during the study period. Significant improvements in the OKS (mean 20.7 points) and range of motion were observed (mean 104.6° at one year). 94.9% of patients were satisfied at one year. Mean correction was to a mechanical femoro-tibial angle of 0.8° varus. Conclusions: We demonstrate excellent medium term survival of the Persona TKA in this large cohort, coupled with improvements in patient reported outcomes, range of motion and patient satisfaction at one year which compare favourably to other implants. [ABSTRACT FROM AUTHOR]

Introduction: Increasing interest in the use of anatomical stems has developed as the prevalence of periprosthetic fractures (PPFs) continues to increase. The primary aim of this study was to determine the long-term survivorship and PPF rate of an anatomical femoral stem in a single UK centre. Patients and methods: Between 2000 and 2002, 94 consecutive THAs were performed using the 170 mm Lubinus SP II anatomical femoral stem in our institution. Patient demographics, operative details and clinical outcomes were collected prospectively in an arthroplasty database. Patient records and national radiographic archives were reviewed finally at a mean of 21.5 years (SD 0.7) following surgery to identify occurrence of subsequent revision surgery, dislocation or periprosthetic fracture. Results: Mean patient age at surgery was 65.8 years (SD 12.5, 34–88 years). There were 48 women (51%). Osteoarthritis was the operative indication in 88 patients (94%). Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (95% confidence interval [CI], 98.0–99.3%) at 10 years and 96.7% (94.5–98.9%) at 21 years. The 20-year stem survival for aseptic loosening was 100% with no cases of significant lysis found (lucent line > 2 mm) and no stems required revision. Patient demographics did not appear to influence risk of revision (p > 0.05). There were 2 revisions in total (2 for acetabular loosening with original stems retained). There were no PPFs identified at mean 21.5 year follow-up and 5 dislocations (5%). Conclusions: The Lubinus SP II 170 mm stem demonstrated excellent survivorship and negligible PPF rates over 20 years following primary THA. [ABSTRACT FROM AUTHOR]

ObjectiveTo explore the feasibility of single incision C7 nerve transfer surgery through the subarachnoid pathway on the healthy side through anatomical research.MethodFour fresh frozen cadaver specimens were used for the study. Observe and measure the length of C7 nerve root fibers. Divide the front root into 3 bundles and the rear root into 5 bundles.ResultThe C7 nerve has a filamentous structure, arranged symmetrically on both sides, and the length of the root fibers gradually shortens from top to bottom. The length of the left anterior root decreased from (12.25 ± 0.68) mm to (9.75 ± 1.40) mm, the length of the right anterior root decreased from (12.95 ± 1.49) mm to (10.00 ± 2.00) mm, the length of the left posterior root decreased from (15.63 ± 1.55) mm to (12.38 ± 0.71) mm, and the length of the right posterior root decreased from (15.48 ± 1.37) mm to (12.30 ± 0.90) mm. The distance from the exit of the C7 nerve from the dura mater to the fusion site in 4 specimens was (10.98 ± 1.21) mm on the left and (10.98 ± 1.391) mm on the right. All four specimens have completed nerve bundle anastomosis.ConclusionFrom an anatomical perspective, it is feasible to anastomose the healthy side C7 nerve with the affected side root fibers in the dorsal bundle of the spinal cord after cutting off the dura mater.

Background: Glenoid retroversion and humeral head subluxation is a progressive disorder due to abnormal force coupling and increased contact force. In situ placement of anatomic total shoulder arthroplasty (TSA) components in this scenario results in edge loading, progressive subluxation, and early failure. Wedged glenoid components have been demonstrated to improve glenohumeral alignment, but have not been correlated with mid-term clinical outcomes. Methods: Patients undergoing TSA using a wedged all-polyethylene glenoid component for retroverted glenoid deformity were identified from a prospectively maintained database. Preoperative planning computed tomography was routinely performed and compared to postoperative correction on radiographic evaluation. Evidence of loosening was correlated to prospectively collect clinical outcome using patient-reported outcome measures. A matched group of neutrally aligned glenohumeral joints undergoing anatomic TSA was used to compare improvement in clinical outcomes. Results: Over a 5-year period, 17 patients with mean age 60 (range 43-81, standard deviation 10.5) were identified with a mean preoperative neoglenoid retroversion of 16.7° (standard deviation 4.5). At a mean follow-up of 43.8 months (range 27-60), no revision surgeries were undertaken. Improvement in the Oxford Shoulder Score was 18 points (P

Background: Repeat hepatectomies are technically complex procedures. The evidence of robotic or laparoscopic (= minimally invasive) repeat hepatectomies (MIRH) after previous open hepatectomy is poor. Therefore, we compared postoperative outcomes of MIRH vs open repeat hepatectomies (ORH) in patients with liver tumors after previous open liver resections. Methods: Consecutive patients who underwent repeat hepatectomies after open liver resections were identified from a prospective database between April 2018 and May 2023. Postoperative complications were graded in line with the Clavien-Dindo classification. We stratified patients by intention to treat into MIRH or ORH and compared outcomes. Logistic regression analysis was performed to define variables associated with the utilization of a minimally invasive approach. Results: Among 46 patients included, 20 (43%) underwent MIRH and 26 (57%) ORH. Twenty-seven patients had advanced or expert repeat hepatectomies (59%) according to the IWATE criteria. Baseline characteristics were comparable between the study groups. The use of a minimally invasive approach was not dependent on preoperative or intraoperative variables. All patients had negative resection margins on final histology. MIRH was associated with less blood loss (450 ml, IQR (interquartile range): 200–600 vs 600 ml, IQR: 400–1500 ml, P = 0.032), and shorter length of stay (5 days, IQR: 4–7 vs 7 days, IQR: 5–9 days, P = 0.041). Postoperative complications were similar between the groups (P = 0.298). Conclusions: MIRH is feasible after previous open hepatectomy and a safe alternative approach to ORH. (German Clinical Trials Register ID: DRKS00032183) [ABSTRACT FROM AUTHOR]

Total shoulder arthroplasty (TSA) is an effective procedure to treat end stage osteoarthritis of the shoulder. Outcomes in patients with neurologic disorders are not well documented. Previous studies have shown that TSA in patients with Parkinson's disease was successful in alleviation of pain, but the overall shoulder function results were poor. We would like to extend this to include more neurologic symptoms. The purpose of this study is to determine the perioperative and the early postoperative outcomes in patients with neurologic disorders undergoing TSA. The Nationwide Readmission Database was used to identify all available primary anatomic TSA (aTSA) and reverse TSA (rTSA) occurring the US from 2011 to 2019 resulting in a total of 428,761 cases of TSA, with 209,789 being aTSA and 218,972 being rTSA. Relevant ICD9 and ICD10 codes identified 3602 (0.8%) patients to have at least 1 neurological disease. Both one way analysis of variance and Chi-squared analyses were used for demographic and comorbidity comparisons. For outcomes analyses, a Chi-squared/Fisher's Exact Test and binary logistic regression were used, which accounted for patient age, sex, primary payer, and Charlson-Deyo comorbidity index. Fisher's Exact Test was used to confirm significance in all low sample size parameters. Significant differences in several demographic categories were found between patients with and without neurological disorders receiving TSA including age (P <.001), sex (P <.001), zip-code income quartile distribution (P <.001), and the primary payer distribution (P <.001). At 180 days, the presence of a neurological condition was significantly predictive of higher rates of extended hospital stay (aTSA: P <.001, rTSA: P <.001) and non–home discharge following both aTSA and rTSA (aTSA: P <.001, rTSA: <0.001). The presence of a neurologic condition was predictive of significantly higher 180-day all-cause complication (P <.001) and mortality rates (P <.001) in patients undergoing rTSA, however this was not seen in those undergoing aTSA. Regarding perioperative complications, in patients undergoing aTSA and rTSA the presence of a neurological condition was significantly predictive of increased complication rates. This study demonstrates that patients with neurologic disorders undergoing TSA are at increased risk for perioperative complications, extended hospital stay, non–home discharge, and mortality out to 180 days. This information is helpful for both patients and surgeons when making an informed decision regarding TSA. Identifying patients with preexisting neurologic disorders before TSA can assist in tailoring preoperative and postoperative management of these patients to improve both short-term and long-term outcomes. [ABSTRACT FROM AUTHOR]

Historically, the association between perioperative complications following general surgery and psychiatric comorbidities has been well established. However, in the ever-changing landscape of total shoulder arthroplasty (TSA) and the population suffering from mental health disorders, research investigating the most current trends on a population level is needed. The purpose of this study is to evaluate the influence a preoperative diagnosis of anxiety, depression, or psychosis has on adverse events, length of stay, and the medical and mechanical complications following TSA at 180 days. The Nationwide Readmissions Database was queried, and 128,382 discharges having undergone a primary TSA between 2010 and 2019 were identified. Subjects were divided into a mental health diagnosis (MHD) and no MHD group. The MHD group was further stratified by the diagnosis of depression, anxiety, or psychosis. Logistic regression analysis was performed for each of the outcome variables. Patients with any MHD were more likely to smoke, suffer from hypertension, and have a higher Charlson-Deyo index. Despite their higher rates of comorbidities, regression analysis revealed that any MHD was an independent predictor of any complication, any mechanical complication, and revision within 180 days ([odds ratio (OR) = 1.26, 95% confidence interval (CI) (1.18, 1.33), P <.001], [OR = 1.50, 95% CI (1.33, 1.67), P <.001], and [OR = 1.54, 95% CI (1.31, 1.64), P <.001, respectively]). Patients undergoing primary TSA with a preoperative MHD are at increased risk of perioperative morbidity. Careful consideration for surgery, as well as discussion and increased postoperative surveillance should be considered in this at-risk population. [ABSTRACT FROM AUTHOR]

Background: Although some data suggest that patients with mutRAS colorectal liver metastases (CRLM) may benefit from anatomic hepatectomy, this topic remains controversial. We performed a systematic review and meta-analysis to determine whether RAS mutation status was associated with prognosis relative to surgical technique [anatomic resection (AR) vs. nonanatomic resection (NAR)] among patients with CRLM. Patients and Methods: A systematic review and meta-analysis of studies were performed to investigate the association of AR versus NAR with overall and liver-specific disease-free survival (DFS and liver-specific DFS, respectively) in the context of RAS mutation status. Results: Overall, 2018 patients (831 mutRAS vs. 1187 wtRAS) were included from five eligible studies. AR was associated with a 40% improvement in liver-specific DFS [hazard ratio (HR) = 0.6, 95% confidence interval (CI) 0.44–0.81, p = 0.01] and a 28% improvement in overall DFS (HR = 0.72, 95% CI 0.54–0.95, p = 0.02) among patients with mutRAS tumors; in contrast, AR was not associated with any improvement in liver-specific DFS or overall DFS among wtRAS patients. These differences may have been mediated by the 40% decreased incidence in R1 resection among patients with mutRAS tumors who underwent AR versus NAR [relative risk (RR): 0.6, 95% CI 0.40–0.91, p = 0.02]. In contrast, the probability of an R1 resection was not decreased among wtRAS patients who underwent AR versus NAR (RR: 0.93, 95% CI 0.69–1.25, p = 0.62). Conclusions: The data suggest that precision surgery may be relevant to CRLM. Specifically, rather than a parenchymal sparing dogma for all patients, AR may have a role in individuals with mutRAS tumors. [ABSTRACT FROM AUTHOR]

Introduction: Accurate positioning of the femoral tunnel in ACL reconstruction is of the utmost importance to reduce the risk of graft failure. Limited visibility during arthroscopy and a wide anatomical variance attribute to femoral tunnel malposition using conventional surgical techniques. The purpose of this study was to determine whether a patient specific 3D printed surgical guide allows for in vitro femoral tunnel positioning within 2 mm of the planned tunnel position. Materials and Methods: A patient specific guide for femoral tunnel positioning in ACL reconstruction was created for four human cadaveric knee specimens based on routine clinical MRI data. Fitting properties were judged by two orthopedic surgeons. MRI scanning was performed both pre- and post-procedure. The planned tunnel endpoint was compared to the actual drilled femoral tunnel. Results: This patient specific 3D printed guide showed a mean deviation of 5.0 mm from the center of the planned femoral ACL origin. Conclusion: In search to improve accuracy and consistency of femoral tunnel positioning in ACL reconstruction, the use of a patient specific 3D printed surgical guide is a viable option to explore further. The results are comparable to those of conventional techniques; however, further design improvements are necessary to improve accuracy and enhance reproducibility. [ABSTRACT FROM AUTHOR]

Approximately 27 million ducks are raised commercially in the US each year and Pekin ducks (Anas platyrhynchos domesticus) are the most commonly raised breed. Additionally, an increasing number of Americans are raising small flocks of poultry, which often include ducks, in their own backyards. This creates a need to better understand the imaging anatomy of ducks. However, in avian species, superimposition of organs limits evaluation of the coelomic cavity using the most common imaging modality, radiography. The use of cross‐sectional imaging including computed tomography (CT) and magnetic resonance imaging (MRI) has increased in veterinary medicine research and clinical use. An anatomic atlas is essential for guiding research and diagnostic imaging. To date, no CT or MRI atlas exists for Pekin ducks. The purpose of the study is to generate a CT atlas of market‐age Pekin ducks as well as CT attenuation values and measurements of coelomic organs with corresponding gross and MRI images. A total of 20 market‐age, commercial Pekin ducks were imaged. Five male and five female ducks were imaged with CT; four of these ten ducks, two male and two female, were frozen and sliced in approximately 5 mm transverse sections for gross anatomic reference images. Six additional ducks, three male and three female ducks, were dissected to measure major organs. Four additional ducks were imaged using CT and MRI and necropsied for gross anatomical comparisons and landmarks. The atlas contained here may be used for future research projects and clinically to aid in diagnosis of disease in ducks. [ABSTRACT FROM AUTHOR]

Background: Periprosthetic joint infections (PJIs) are a major cause of morbidity after shoulder arthroplasty. Prior national database studies have estimated the trends of shoulder PJI up to 2012.21 Since 2012, the landscape of shoulder arthroplasty has changed drastically with the expanding popularity of reverse total shoulder arthroplasty. The dramatic growth in primary shoulder arthroplasties is likely paralleled with an increase of PJI case volume. The purpose of this study is to quantify the rise in shoulder PJIs and the economic stress they currently place on the American healthcare system as well as the toll they will incur over the coming decade. Methods: The Nationwide Inpatient Sample database was queried for primary and revision anatomic total shoulder arthroplasty, reverse total shoulder arthroplasty, and hemiarthroplasty from 2011-2018. Multivariate regression was used to predict cases and charges through the year 2030 adjusted to 2021 purchasing power parity. Results: From 2011 to 2018, PJI was found to be 1.1% shoulder arthroplasties, from 0.8% (2011) to 1.4% (2018). Anatomic total shoulder arthroplasty experienced the greatest proportion of infections at 2.0%, followed by hemiarthroplasty at 1.0% and reverse total shoulder arthroplasty at 0.3%. Total hospital charges grew 324%, from $44.8 million (2011) to $190.3 million (2018). Our regression model projects 176% growth in cases and 141% growth in annual charges by 2030. Conclusion: This study demonstrates the large economic burden that shoulder PJIs pose on the American healthcare system, which is predicted to reach nearly $500 million in charges annually by 2030. Understanding trends in procedure volume and hospital charges will be critical in evaluating strategies to reduce shoulder PJIs.

Introduction: Anatomical femoral tunnel placement is critical for anterior cruciate ligament reconstruction (ACLR). Tunnel placement may vary with different surgical techniques. The aim of this study was to compare the accuracy of femoral tunnel placement between the Anteromedial (AM) and Anterolateral (AL) visualisation portals on post-operative CT scans among a cohort of ACLR patients. Materials and methods: This cross-sectional study was conducted from January 2018 to March 2020 after obtaining ethics clearance. Patients who went for arthroscopic ACLR in our institute were divided into an AM (group 1) and an AL (group 2) based on the visualisation portal for creating the femoral tunnel and a 3D CT scan was done. The femoral tunnel position was calculated in deep to shallow and high to low direction using the Bernard Hertel grid. Femoral tunnel angle was measured in the 2D coronal image. Statistical analysis was done with the data collected. Results: Fifty patients with an average age of 26.36 (18-55) years ±7.216 SD were enrolled in the study. In this study, the AM technique was significantly more accurate (p

With the help of computational fluid dynamics (CFD), hemodynamics of the pulmonary arteries (PA's) can be studied in detail and varying physiological circumstances and treatment options can be simulated. This offers the opportunity to improve the diagnostics and treatment of PA stenosis in biventricular congenital heart disease (CHD). The aim of this review was to evaluate the methods of computational studies for PA's in biventricular CHD and the level of validation of the numerical outcomes. A total of 34 original research papers were selected. The literature showed a great variety in the used methods for (re) construction of the geometry as well as definition of the boundary conditions and numerical setup. There were 10 different methods identified to define inlet boundary conditions and 17 for outlet boundary conditions. A total of nine papers verified their CFD outcomes by comparing results to clinical data or by an experimental mock loop. The diversity in used methods and the low level of validation of the outcomes result in uncertainties regarding the reliability of numerical studies. This limits the current clinical utility of CFD for the study of PA flow in CHD. Standardization and validation of the methods are therefore recommended.

Background and purposeSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is associated with an increased rate of cerebrovascular events including ischemic stroke and intracerebral hemorrhage. The mechanisms underlying cerebral endothelial susceptibility and response to SARS-CoV-2 are unknown yet critical to understanding the association of SARS-CoV-2 infection with cerebrovascular events.MethodsEndothelial cells were isolated from human brain and analyzed by RNA sequencing. Human umbilical vein and human brain microvascular cells were used in both monolayer culture and endothelialized within a 3-dimensional printed vascular model of the middle cerebral artery. Gene expression levels were measured by quantitative polymerase chain reaction and direct RNA hybridization. Recombinant SARS-CoV-2 S protein and S protein-containing liposomes were used to measure endothelial binding by immunocytochemistry.ResultsACE2 (angiotensin-converting enzyme-2) mRNA levels were low in human brain and monolayer endothelial cell culture. Within the 3-dimensional printed vascular model, ACE2 gene expression and protein levels were progressively increased by vessel size and flow rates. SARS-CoV-2 S protein-containing liposomes were detected in human umbilical vein endothelial cells and human brain microvascular endothelial cells in 3-dimensional middle cerebral artery models but not in monolayer culture consistent with flow dependency of ACE2 expression. Binding of SARS-CoV-2 S protein triggered 83 unique genes in human brain endothelial cells including upregulation of complement component C3.ConclusionsBrain endothelial cells are susceptible to direct SARS-CoV-2 infection through flow-dependent expression of ACE2. Viral S protein binding triggers a unique gene expression profile in brain endothelia that may explain the association of SARS-CoV-2 infection with cerebrovascular events.

Various patellar designs are used in total knee arthroplasty (TKA) for optimal management of patellofemoral pain. The aim of this study was to compare postoperative 2-year clinical outcomes of 3 patellar designs: medialized anatomic (MA), medialized dome (MD), and Gaussian dome (GD). In this randomized controlled trial, 153 patients undergoing primary TKA from 2015 to 2019 were enrolled. Patients were allocated to 3 groups (MA, MD, and GD). Demographic characteristics, clinical variables including knee flexion angle and patient-reported outcome measures (Kujala score, Knee Society Scores, the Hospital for Special Surgery score, and The Western Ontario and McMaster Universities Arthritis Index), and complications were collected. Radiologic parameters including Blackburne-Peel ratio and patellar tilt angle (PTA) were measured. A total of 139 patients who completed postoperative follow-up for 2 years were analyzed. Knee flexion angle and patient-reported outcome measures did not statistically differ among the 3 groups (MA, MD, and GD). There were no extensor mechanism-related complications at any group. Group MA showed significantly higher mean values of postoperative PTA than group GD (0.1 ± 3.2 versus −1.8 ± 3.4, P =.011). Group GD (20.8%) had a tendency to have more outliers (over 5 degrees) in PTA than groups MA (10.6%) and MD (4.5%), although the differences were not statistically significant (P =.092). Anatomic patellar design was not clinically superior over dome design in TKA, showing comparable results in terms of clinical scores, complications, and radiographic indices. [ABSTRACT FROM AUTHOR]

Tennis and other racket sports remain popular among active patients considering shoulder arthroplasty. While the ability to return to tennis following hip and knee arthroplasty has been previously studied, the capacity to participate following shoulder arthroplasty is less well known, especially following reverse shoulder arthroplasty (RSA), which alters shoulder kinematics. The purpose of this study is to characterize the return to racket sports following both total shoulder arthroplasty (TSA) and RSA. The secondary objectives were to evaluate: 1) performance; 2) change in patient-reported outcome measures; 3) range of motion (ROM); and 4) satisfaction of patients who returned to racket sports after TSA. This is a retrospective cohort study of 43 patients identified as playing a racket sport before undergoing either anatomic TSA or RSA. All patients were cleared to return to racket sports activities beginning 3 months following surgery. Patients were contacted by phone or email and a racket sport-specific questionnaire was administered, focusing on their experience returning to racket sports. The results following TSA were compared with those who received RSA. The median age at surgery was 71 (66-75) years, with 26 TSA and 13 RSA patients. Of the 43 patients, 90% were able to return to sport, 4 (3 RSA, 1 TSA) stated that they were unable to return due to a shoulder-related complaint. Of the 39 patients still playing, 19 (49%) returned within 6 months and 33 (85%) returned within 12 months, with no differences among cohorts (P =.344). Overall perceived performance following surgery stayed the same or improved in 90% of the patients. Similarly, overall enjoyment of racket sports either improved or stayed the same in 98% of patients. Pain experienced during sport improved significantly from a median Visual Analogy Scale pain score of 5-0 (P <.001) with no significant difference seen when comparing RSA and TSA. The dominant arm was treated in 14 (54%) TSA and 8 (62%) RSA patients with minimal impact on outcomes. Return to racket sports following both reverse and anatomic TSA is a realistic expectation, along with significant improvements in both pain and sport-specific function while playing. Patients treated with anatomic and RSA can expect similar recovery and racket sport experiences following surgery, with no significant differences between either surgery. [ABSTRACT FROM AUTHOR]

Background: Anatomic restoration of the humeral head is critical for successful shoulder replacement. Accurate measurements of the humeral head are essential for anatomic substitution. Purpose: To evaluate whether a best-fit circle of the humeral head, as determined from different projections of plain radiographs, can predict the humeral head implant size for either the left or right shoulder. Study Design: Descriptive laboratory study. Methods: Bilateral shoulder radiographs of 200 patients without arthropathy or other abnormal findings of the humeral head were evaluated. The best-fit circle was obtained based on 3 points: the medial and lateral endpoints of the anatomic neck and the lateral cortex below the greater tuberosity. This circle was drawn on 5 different radiographic projections (shoulder anteroposterior [AP], glenoid AP, outlet, axillary, and 30° caudal tilt) of the left and right shoulders of each patient, and the radius of each circle was measured. Agreement in the best-fit circle radius between the left and right shoulders was statistically analyzed using the intraclass correlation coefficient (ICC). There were 2 independent blinded observers who performed each measurement twice to evaluate inter- and intraobserver reliability. Results: Overall agreement in the radius between the right and left shoulders was excellent (all ICCs ≥0.990). The ICCs according to the radiographic view were 0.990 (95% CI, 0.986-0.993) for shoulder AP, 0.992 (95% CI, 0.989-0.995) for glenoid AP, 0.996 (95% CI, 0.994-0.997) for outlet, 0.994 (95% CI, 0.991-0.996) for axillary, and 0.993 (95% CI, 0.990-0.995) for 30° caudal tilt. Interobserver ICCs demonstrated a high level of precision: 0.987 (95% CI, 0.978-0.993) for shoulder AP, 0.986 (95% CI, 0.974-0.992) for glenoid AP, 0.974 (95% CI, 0.954-0.985) for outlet, 0.991 (95% CI, 0.984-0.995) for axillary, and 0.987 (95% CI, 0.977-0.993) for 30° caudal tilt. Intraobserver ICCs demonstrated excellent test-retest reliability: 0.983 (95% CI, 0.970-0.991) for shoulder AP, 0.989 (95% CI, 0.980-0.994) for glenoid AP, 0.987 (95% CI, 0.978-0.993) for outlet, 0.985 (95% CI, 0.973-0.991) for axillary, and 0.970 (95% CI, 0.947-0.983) for 30° caudal tilt. Conclusion: The best-fit circle to calculate the ideal size of a humeral head implant was able to be determined from different projections of plain radiographs. Clinical Relevance: Anatomic restoration of a deformed humeral head can be achieved using the best-fit circle of the contralateral humeral head as obtained from plain radiographs. This method can facilitate preoperative planning and postoperative evaluation in the anatomic restoration of the shoulder to avoid the problems of overstuffing. [ABSTRACT FROM AUTHOR]

Reef-building corals and their aragonite (CaCO3) skeletons support entire reef ecosystems, yet their formation mechanism is poorly understood. Here we used synchrotron spectromicroscopy to observe the nanoscale mineralogy of fresh, forming skeletons from six species spanning all reef-forming coral morphologies: Branching, encrusting, massive, and table. In all species, hydrated and anhydrous amorphous calcium carbonate nanoparticles were precursors for skeletal growth, as previously observed in a single species. The amorphous precursors here were observed in tissue, between tissue and skeleton, and at growth fronts of the skeleton, within a low-density nano- or microporous layer varying in thickness from 7 to 20 µm. Brunauer-Emmett-Teller measurements, however, indicated that the mature skeletons at the microscale were space-filling, comparable to single crystals of geologic aragonite. Nanoparticles alone can never fill space completely, thus ion-by-ion filling must be invoked to fill interstitial pores. Such ion-by-ion diffusion and attachment may occur from the supersaturated calcifying fluid known to exist in corals, or from a dense liquid precursor, observed in synthetic systems but never in biogenic ones. Concomitant particle attachment and ion-by-ion filling was previously observed in synthetic calcite rhombohedra, but never in aragonite pseudohexagonal prisms, synthetic or biogenic, as observed here. Models for biomineral growth, isotope incorporation, and coral skeletons' resilience to ocean warming and acidification must take into account the dual formation mechanism, including particle attachment and ion-by-ion space filling.

The purpose of this study is to investigate the feasibility and performance of a stationary, non-focused dual-sectored tubular transurethral ultrasound applicator for thermal exposure of tissue regions adjacent to the urethra for treatment of stress urinary incontinence (SUI) through acoustic and biothermal simulations on 3D anatomical models. Parametric studies in a generalized tissue model over dual-sectored ultrasound applicator configurations (acoustic surface intensities, lateral active acoustic output sector angles, and durations) were performed. Selected configurations and delivery strategies were applied on 3D pelvic anatomical models. Temperature and thermal dose distributions on the target region and surrounding tissues were calculated. Endovaginal cooling was explored as a strategy to mitigate vaginal heating. The 75-90° dual-sectored transurethral tubular transducer (3.5 mm outer diameter (OD), 14 mm length, 6.5 MHz, 8.8-10.2 W/cm2) and 2-3-min sonication duration were selected from the parametric study for acoustic and biothermal simulations on anatomical models. The transurethral applicator with two opposing 75-90° active lateral tubular sectors can create two heated volumes for a total of up to 1.8 cm3 over 60 EM43 °C, with at least 10 mm radial penetration depth, 1.2 mm urethral sparing, and no lethal damage to the vagina and adjacent bone (