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ObjectiveRecent reports have shown that outpatient shoulder arthroplasty (SA) may be a safe alternative to inpatient management in appropriately selected patients. The purpose was to review the literature reporting on outpatient SA.MethodsA systematic review of publications on outpatient SA was performed. Included publications discussed patients who were discharged on the same calendar day or within 23 hours from surgery. Articles were categorized by discussions on complications, readmissions, and safety, patient selection, pain management strategies, cost effectiveness, and patient and surgeon satisfaction.ResultsTwenty-six articles were included. Patients undergoing outpatient SA were younger and with a lower BMI than those undergoing inpatient SA. Larger database studies reported more medical complications for patients undergoing inpatient compared to outpatient SA. Articles on pain management strategies discussed both single shot and continuous interscalene blocks with similar outcomes. Both patients and surgeons reported high levels of satisfaction following outpatient SA, and cost analysis studies demonstrated significant cost savings for outpatient SA.ConclusionIn appropriately selected patients, outpatient SA can be a safe, cost-saving alternative to inpatient care and may lead to high satisfaction of both patients and physicians, though further studies are needed to clarify appropriate utilization of outpatient SA.

BackgroundGlenoid retroversion and humeral head subluxation have been suggested to lead to inferior outcomes after total shoulder arthroplasty (TSA). There are limited data to support this suggestion. We investigated whether preoperative glenoid retroversion and humeral head subluxation are associated with inferior outcomes after TSA and whether change of retroversion influences outcomes after TSA.MethodsPatients undergoing TSA with minimum 2-year follow-up were included from a prospectively collected institutional shoulder arthroplasty database. Retroversion and humeral head subluxation before and after surgery were measured on axillary radiographs. Postoperative radiographs were -evaluated for glenoid component loosening and compared between groups. Spearman correlations were determined between retroversion measurements and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores. Patients were analyzed in groups based on retroversion and humeral head subluxation.ResultsThere were 113 patients (50% follow-up rate) evaluated at 4.2 years postoperatively. The mean preoperative retroversion (15.3° ± 7.7°) was significantly higher than postoperative retroversion (10.0° ± 6.8°; P < .0001). There was no correlation between postoperative glenoid version or humeral head subluxation and ASES scores. For patients with preoperative retroversion of >15°, there was no difference in outcome scores based on postoperative retroversion. There were no differences in preoperative or postoperative version for patients with or without glenoid lucencies.DiscussionWe observed no significant relationship between postoperative glenoid retroversion or humeral head subluxation and clinical outcomes in patients following TSA. For patients with preoperative retroversion >15°, change of retroversion during TSA had no impact on their clinical outcomes at short-term follow-up.

PURPOSE OF REVIEW:Anterior cruciate ligament (ACL) injury is one of the most common ligamentous injuries suffered by athletes participating in cutting sports. A common misperception is that ACL reconstruction can prevent osteoarthritis (OA). The goal of this paper is to review and discuss the contributing factors for the development of OA following ACL injury. RECENT FINDINGS:There has been interesting new research related to ACL reconstruction. As understanding of knee biomechanics following ACL injury and reconstruction has changed over time, many surgeons have changed their surgical techniques to low anterior drilling to position their femoral tunnel in an attempt to place the ACL in a more anatomic position. Even with this change in the femoral tunnel position, 85% of knees following ACL reconstruction have abnormal tibial motion compared to contralateral non-injured knees. Studies have shown increases in inflammatory cytokines in the knee following ACL injury, and newer MRI sequences have allowed for earlier objective detection of degenerative changes to cartilage following injury. Recent studies have shown that injecting IL-1 receptor antagonist and corticosteroids can modulate the post-injury inflammatory cascade. ACL reconstruction does not prevent the development of OA but can improve knee kinematics and reduce secondary injury to the cartilage and meniscus. Advancements in imaging studies has allowed for earlier detection of degenerative changes in the knee, which has allowed researchers to study how new interventions can alter the course of degenerative change in the knee following ACL injury.

PURPOSE OF REVIEW:The most common complications warranting revision consideration in reverse shoulder arthroplasty (RSA) include instability and its associated causes: infection, periprosthetic fracture, and glenoid baseplate loosening. Management of complications can be challenging and the nuances of treatment are still being elucidated. The focus of this paper is to review the treatment of the failed RSA and discuss evidence-based recommendations for revision. RECENT FINDINGS:The most common complications requiring revision RSA are instability and infection. The causes for instability can be subdivided into three main subcategories: loss of compression, loss of containment, and impingement. Loss of compression is further broken down into 6 subcategories revolving around abnormal prosthesis positioning, undersized prostheses, or intrinsic soft-tissue tension loss leading to instability. Periprosthetic infection can also lead to instability, yet the most appropriate management for infected RSA remains controversial. Restoring stability by maximizing deltoid and soft tissue tension while avoiding impingement revolves around three basic methods: (1) lateralizing and/or upsizing the glenosphere to an inferior position on the glenoid, (2) use of a more constrained polyethylene insert, and (3) distalizing the humerus by increasing the polyethylene thickness and/or the thickness of the humeral tray. Management of periprosthetic joint infection can be performed in one-stage, two-stage, or "three-stage" procedures all showing good outcomes with two-stage procedures being the most commonly performed. However, persistent positive culture with propriobacterium acnes can occur in up to 25% of cases. In order to limit the associated morbidity from failed revision reverse shoulder arthroplasty, continued research on best management of associated complications is warranted.

BackgroundImplant-related symptoms are the most common reason for reoperation after open reduction and internal fixation (ORIF) of midshaft clavicular fractures. Dual mini-fragment plate fixation is a relatively new solution that may decrease implant prominence while maintaining fixation strength and function. There are minimal published data comparing reoperation rates and clinical outcomes between single, superior-plate constructs and dual mini-fragment plate constructs in the fixation of midshaft clavicular fractures. We hypothesized that reducing plate size with the use of dual mini-fragment plating compared with standard, 3.5-mm, superior plating would minimize implant symptoms and the corresponding need for reoperation while still providing sufficient fixation to allow fracture-healing and return to function.MethodsWe retrospectively reviewed the cases of 44 consecutive patients who underwent ORIF of displaced midshaft clavicular fractures utilizing either a single, 3.5-mm, superior plate construct (21 patients) or a dual, 2.7-mm and 2.4-mm, plate construct (23 patients). Outcomes at a minimum of 2 years were assessed. Primary outcome measures included reoperation for any reason and the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, patient self-report section.ResultsThere was a 100% union rate in both groups. None (0%) of the 23 patients who received the dual (2.7-mm and 2.4-mm) plate construct and 6 (29%) of the 21 patients who received the single (3.5-mm) plate construct underwent reoperation for implant-related symptoms. Using a Fisher exact test, the rate of reoperation was compared between the groups, and the difference was found to be significant (p = 0.008). Using an unpaired t test, the difference in mean ASES scores was not significant (p = 0.138) between the dual-plate group (98 of 100) and the single superior plate group (96 of 100) with retained implants.ConclusionsIn our comparative retrospective series, dual fixation utilizing a 2.7-mm superior plate and a 2.4-mm anterior plate for the treatment of displaced midshaft clavicular fractures was associated with a significantly lower rate of reoperation when compared with single, 3.5-mm, superior plate fixation.Level of evidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

BackgroundThere are limited data on the effect of glenoid retroversion in clinical outcomes following reverse total shoulder arthroplasty (RTSA). The purpose of this study was to evaluate if surgical correction of retroversion affects outcomes following RTSA.MethodsAn institutional database was utilized to identify 177 patients (mean age: 68.2 ± 10.1 years) with minimum 2-year follow-up after primary RTSA. Glenoid version was measured on preoperative and postoperative radiographs. American Shoulder and Elbow Surgeons (ASES) scores and range of motion were collected before and after RTSA. Change in retroversion was determined by comparing preoperative and postoperative glenoid retroversion on radiographs using paired Wilcoxon signed-rank test. Spearman's rank correlation was used to investigate relationships between ASES scores and glenoid retroversion.ResultsThe mean postoperative ASES composite score (75.5 ± 22.7) was significantly higher than preoperative (36.8 ± 19.2; P

BackgroundPositive-pressure air arthrography and venting of the hip capsule are techniques used to decrease the traction forces needed for joint distraction during hip arthroscopic surgery. Little is known about the effects that these techniques have on postoperative pain.HypothesisPositive-pressure air arthrography and venting during hip arthroscopic surgery will decrease patient-reported pain and narcotic requirements in the acute postoperative setting.Study designCohort study; Level of evidence, 3.MethodsA retrospective cohort analysis was conducted to analyze 35 patients who underwent positive-pressure air arthrography and venting to aid joint distraction during hip arthroscopic surgery versus a group with similar demographics, pathologies, and treatments who did not undergo air arthrography. Numeric pain rating scale (NPRS) scores and medication administration including narcotic and nonnarcotic analgesia in the postanesthesia care unit (PACU) were tracked and compared.ResultsThe maximum (7.17 vs 4.97, respectively), minimum (2.43 vs 1.09, respectively), and mean (5.15 vs 3.11, respectively) NPRS scores were all higher in the control group compared with the air arthrogram group (P < .001, P = .007, and P < .001, respectively). The administration of oral morphine equivalents (OMEs) during the PACU stay was significantly lower in the air arthrogram group, with a mean of 36.75 ± 11.37 OMEs, compared with 44.53 ± 16.06 OMEs in the control group (P = .023). There was no difference in postoperative nonopioid medications, such as ketorolac or acetaminophen, given between groups.ConclusionPatients undergoing hip arthroscopic surgery with air arthrography and venting used to aid distraction had significantly less postoperative pain and required a lower total dosage of opioids during their PACU stay when compared with patients who underwent hip arthroscopic surgery without air arthrography.

The primary goal of engineering outreach is to attract prospective students to engineering education and the engineering profession. Gifted students, especially those identified as possessing unusually high abilities in science and technology, are especially promising students to attract to careers in engineering. It is critical to cultivate these students' interests and develop their potential for engineering while encouraging them to pursue engineering studies beyond K-12 education. This article presents examples of the successful learning outcomes of an ongoing University-based Electronics Technology Project Study (UETPS) program, a joint endeavor between the IEEE Hong Kong Section, the Education Bureau of the Hong Kong SAR Government, and the Hong Kong Academy of Gifted Education (HKAGE). The UETPS program promotes electrical, electronic, and computer engineering education in Hong Kong and is aimed particularly at gifted students as well as their parents, teachers, and schools. Project applicants underwent formal identification procedures by the Gifted Education Section of the HKSAR Education Bureau and were identified as being gifted in the area of science and technology. Selected participants then participated in one-year research projects in electronics and computer engineering under the guidance of university professors in their respective engineering departments. This program addresses an urgent need of the engineering education sector by reaching out to highly talented K-12 students and their surrounding communities. According to the evaluation results, the UETPS program has significantly enhanced the participating students' interest in engineering as a career choice and encouraged them to pursue undergraduate studies in engineering. This article also discusses lessons learned and proposes strategies for future potential implementers. (Contains 3 tables and 5 figures.)

In traditional teleoperation systems, the human operator is saddled with two distinct tasks: 1) moving the robot arm to its desired position, and 2) avoiding obstacles that can obstruct the arm motion. The current robot teleoperation research concentrates on providing the operator with as much input information about the task site as possible using, for example, stereo vision or contact force feedback. These methods presume that the operator is capable of planning motion for the entire body of the robot in a cluttered environment. Studies show, however, that the operators, first, cannot address both tasks in real time, and second, are not good at generating collision-free motion in a complex environment. Recent results in sensor-based motion planning suggest that the collision avoidance task can be handled automatically, thus freeing the operator for global control. To this end, it is also proposed to use whole-sensitive arm manipulators whose whole bodies are covered with a sensitive skin sensor to detect nearby objects. The data from the skin is processed by motion planning algorithms, to avoid collisions for the entire arm body in an unknown or time-varying environment. The motion of the operator-controlled master arm is either repeated faithfully by the slave arm, or, to avoid collisions, is used as general guidance. In the latter case the slave arm attempts to be as close as possible to the positions commanded by the operator, without jeopardizing its safety. The result is an efficient, safe and robust hybrid system in which integration of control by the operator and the automatic system is done transparently and in real time.

A proposed system architecture for sensor-based motion planning of a three-dimensional robot arm manipulator is modeled through a prototype. The arm operates within an environment of which the system has no prior knowledge. The proposed sensitive skin covering the arm is designed with a sensing medium which uses amplitude modulated infrared light. A flexible circuit board serves as the skin surface and carries nearly 500 proximity sensors. The prototype monitors this surface every 1/16th of a second.