Search

Background: Rotator cuff repairs may fail because of compromised blood supply, suture anchor pullout, or poor fixation to bone. To augment the repairs and promote healing of the tears, orthobiologics, such a platelet-rich plasma (PRP), and biologic scaffolds have been applied with mixed results. Adipose allograft matrix (AAM), which recruits native cells to damaged tissues, may also be a potential treatment for rotator cuff tears. Methods: To assess the potential use of AAM on rotator cuff tears, humeral head cartilage and subscapularis tendon were collected from patients undergoing reverse shoulder arthroplasty (RSA). Punch biopsies of the tissues were used to create explants for tissue culture, and the remaining tissue was digested to isolate the chondrocytes and tenocytes for cell culture. Explants and cells were then cultured in media containing AAM. After 48 h, the tissues and cells were measured for cell viability, cell proliferation, extracellular matrix (ECM) and metalloproteinase (MMP) gene expression and for MMP, inflammatory cytokine, and growth factor concentrations. Results: Cell viability was increased in humeral head chondrocytes and rotator cuff tenocytes cultured with AAM. Gene expression of the matrix proteoglycan, aggrecan, and of the proteolytic enzyme MMP-13 were downregulated in humeral head chondrocytes. MMP-13 concentrations were increased in subscapularis tenocytes and in humeral head chondrocyte/subscapularis tenocyte co-cultures. The anti-inflammatory cytokine, IL-1ra was increased in cartilage/tendon explant co-cultures. TGF-β1 concentrations were increased in chondrocytes, but decreased in tenocytes. Conclusions: Overall, AAM had no significant negative effects on the cells or explants. The results of these experiments provide the basis for the future use of AAM as a scaffolding for tissue engineering, preclinical animal models of rotator cuff tear and glenohumeral osteoarthritis, and clinical models. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Purpose: Reverse shoulder arthroplasty (RSA) is a common surgical procedure for elderly patients with proximal humerus fractures. Cement fixation of the humeral stem is considered the gold standard for this procedure. Due to the high prevalence of osteoporosis in this patient population, the risk of intraoperative fractures is increased when uncemented stems are used. Stem loosening is another concern of uncemented stems. However, the use of cement is associated with the risk of cement embolisation, impairment of tuberosity healing, and technical difficulties for later revisions. This study aimed (i) to evaluate the clinical and radiological outcomes of patients treated with uncemented RSA for proximal humerus fractures at two years postoperatively, and (ii) to compare these outcomes between patients with and without decreased low bone quality as measured by the deltoid tuberosity index. Methods: The single-centre prospective study included 54 shoulders (52 patients) with a proximal humerus fracture between 2019 and 2022. Enrolled were patients aged 65 and older with acute or secondary displaced three- or four-part fractures or head-split fractures treated with RSA using the same uncemented system and tubercula refixation. At 24 months post-surgery, clinical evaluations included range of motion (ROM), Constant-Murley Score (CS), Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons (ASES) Score. Radiological assessments evaluated scapular notching, radiolucent lines, and greater tuberosity healing. Results: The mean age was 79 years (± 8), 87% were female, and 69% had osteoporotic fractures. At the two-year follow-up, the median SSV was 90% (IQR 80–95), the median CS Score was 76.5 (IQR 72–81), and the median ASES Score was 89.9 (IQR 82–93). The ROM measurements were: median active forward flexion 140° (IQR 120–160), median external rotation 30° (IQR 20–40), and median active internal rotation 6 (IQR 4–8). The greater tuberosity healing rate was 94.5%. Although osteoporotic fractures occurred more often in older patients (mean 81 vs. 72 years, respectively), no other significant differences were detected between the groups. One case of aseptic stem loosening occurred in the non-osteoporotic group. Conclusion: Even in osteoporotic proximal humerus fractures, cementless stems combined with tubercula refixation resulted in favourable outcomes and were not associated with increased complications. [ABSTRACT FROM AUTHOR]

Purpose: Scapular Notching (SN) is one of the most common postoperative complications for a patient after Reverse Total Shoulder Arthroplasty (RTSA). Despite employing various strategies to mitigate SN risk, the overall incidence remains far from zero. This article introduces a new risk factor, the scapulo-humeral angle (SHA), as a key element influencing the risk for SN. Methods: A retrospective analysis was conducted on all patients who underwent RTSA for rotator cuff arthropathy at the study centre. The preoperative SHA was measured, and the presence of SN was investigated and graded using the Nerot classification at the latest follow-up. Results: 42 patients were included. 12 presented SN (incidence 28.5%). A statistically significant Pearson coefficient correlation between pre-operative SHA and the incidence of SN was observed (r= -0.6954; 95% C.I. -0,8250 to -0,4963; p < 0.0001). A statistically significant Pearson coefficient correlation was also found between the degree of SN and the pre-operative SHA (r= -0,7045; 95% C.I. -0,8306 to -0,5096; P value (two-tailed) < 0,0001, alpha 0.05). Conclusions: The primary finding is a statistically significant correlation between a reduced preoperative SHA and an increased incidence of postoperative SN. The secondary finding is that a smaller preoperative SHA is associated with a more severe degree of SN A SHA cut-off of 50° distinguished patients at high risk of SN from those at low risk. All patients with an SHA below 50° developed SN (10/10), whereas only 6.25% of patients with an SHA exceeding 50° experienced SN (2/32). [ABSTRACT FROM AUTHOR]

Background: The number of reverse shoulder arthroplasty (RSA) procedures performed worldwide has increased over the last 10 years, with a corresponding increase in revision shoulder arthroplasty (SRSA). SRSA is often used for post-traumatic revision surgery in cases of infections and failure of anatomical prostheses. Data on outcomes with specific detail for each indication for the prosthetic solution as a secondary treatment are scarce, and inhomogeneous. Methods: The questionnaires were sent by mail to 65 patients who underwent SRSA between January 2014 and November 2023. Based on the indications for SRSA, patients were categorized into post-traumatic shoulder arthritis, humeral head necrosis, failed proximal humerus fractures, failed proximal humerus osteosynthesis, prostheses loosening, and infection groups. Results: Of the 65 patients included in the study, 39 completed the questionnaire, and the mean follow-up duration was 44 months (range, 12–104 months). The Constant score ranged from 28 points for all 6 groups (range, 38–66). The post-infection group showed the highest results, with 66 points (range, 24–90) on the Constant score; followed by 26 points (range, 49–6) points on the DASH score; and 0.90 (range, 0.763–1) on the EQ-5D-5L. Failed proximal humerus fractures presented the lowest scores: 38 points (range, 22–63) on the Constant score; 51 points (range, 73–30) points on the DASH score; and 0.61 (range, -0.496–1) on the EQ-5D-5L. Conclusions: No previous study has investigated the influence of indications on the clinical outcome of SRSA so circumstantial. In this study, the highest outcome scores were observed in the post-infection group, whereas the lowest scores were observed in the failed humerus fracture group. Our results underline the influence of the indication on the clinical outcome of SRSA. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to determine preoperative patient- and fracture-related risk factors for estimating the risk of fracture sequelae after surgically treated proximal humerus fractures (PHF) using locking plate osteosynthesis. The purpose was to develop a fracture sequelae risk score as an additional tool to facilitate the treatment strategy for PHF. Methods: All patients with PHF who underwent surgery with locking plate osteosynthesis were included. Inclusion criteria were complete preoperative parameters including general patient-specific information, preoperative radiographs and computed tomography (CT) scans. The patients were divided into 2 groups according to the occurrence of fracture sequelae (Group I: no fracture sequelae, Group II: fracture sequelae). Following risk factors for fracture sequelae were defined: Vascular supply interruption risk [V], Individual (female gender) [I], Diabetes [D], ISAR (Identification of Seniors at risk) [I], ASA (American Society of Anesthesiologists) score [A], Body mass index [B], Osteopenia [O], Nicotine abuse [N], Elderly > 65 [E]. The VIDIA BONE score contains 9 items. For each parameter of the VIDIA BONE score, a value between 1 and 3 was assigned based on the odds ratio (OR). Results: This comparative case series study included 112 patients, with 82 (73.2%) in Group I and 30 (26.8%) in Group II. All defined preoperative risk factors were associated with an increased risk of fracture sequelae (FS), with odds ratios (OR) ranging from 1.3 to 3.9, although not all parameters reached statistical significance. The maximum score was 24 points, categorized as follows: scores of 1 to 8 indicating low risk, 9 to 16 indicating moderate risk, and 17 to 24 indicating high risk of fracture sequelae following PHF. Patients with a VIDIA BONE score of 1 to 8 points demonstrated favorable postoperative outcomes, with FS observed in only 6% of cases. In contrast, 84% of patients with a score of 17 to 24 developed a FS. Additionally, 90% of all patients who developed FS had a VIDIA BONE score more than 9 points. Conclusion: The VIDIA BONE score appears to be a simple, reproducible, and valuable tool for supporting reliable treatment decisions. Locking plate osteosynthesis is an effective treatment option for patients with a low risk VIDIA BONE score. However, patients with a high risk VIDIA BONE score are more likely to experience FS and osteosynthesis failure. Level of evidence: III. [ABSTRACT FROM AUTHOR]

The editorial "What's New in Musculoskeletal Tumor Surgery" highlights recent advancements in musculoskeletal tumor surgery, focusing on soft-tissue sarcomas, tenosynovial giant cell tumors, prevention of thromboembolic complications, and international collaboration in orthopaedic oncology. The document discusses innovative approaches such as molecular diagnostics, machine learning, immunotherapy, and predictive models for prognosis and treatment planning. It also addresses wound management strategies, surgical techniques for bone sarcomas, and the challenges of managing metastatic bone disease. The editorial emphasizes the importance of personalized treatment planning, subtype-specific approaches, and ongoing research to optimize patient care and outcomes in the field of musculoskeletal tumor surgery. [Extracted from the article]

ABSTRACT Background Method Results Conclusion It is still unclear whether reverse total shoulder arthroplasty (RTSA) has advantages over traditional hemiarthroplasty (HA) and anatomic total shoulder arthroplasty (ATSA) in the treatment of complex shoulder joint diseases. Therefore, this study aims to evaluate the clinical effectiveness of RTSA in the treatment of complex shoulder joint diseases and further determine whether it is necessary to expand the indications of RTSA.We conducted a systematic search of studies published between January 1, 2012 and May 31, 2023 in PubMed, Embase, and Cochrane databases. The experimental group included patients who underwent primary reverse total shoulder arthroplasty (RTSA), while the control group consisted of patients who underwent primary hemiarthroplasty (HA) or anatomic total shoulder arthroplasty (ATSA). The minimum follow‐up period was 1 year, and a random‐effects model was utilized for data synthesis.A total of 45 studies were included in the meta‐analysis. Compare to HA, RTSA showed significant advantages in postoperative ASES scores (p = 0.004), forward flexion (p < 0.0001), and abduction (p < 0.0001). Compare to ATSA, RTSA showed significantly lower postoperative Constant scores (p = 0.004), ASES scores (p = 0.001), SST scores (p < 0.0001), forward flexion (p < 0.0001), abduction (p = 0.011), internal rotation (p < 0.0001), and external rotation (p < 0.0001). Further meta regression analysis was conducted, considering factors such as region, age, gender ratio, and follow‐up time, excluding the influence of relevant factors. Overall, RTSA did not demonstrate advantages in postoperative functional scores and range of motion. In terms of complication and revision rates, RTSA had lower rates compared to HA and ATSA, except for the complication rate, where there was no significant difference between RTSA and ATSA (p = 0.521), but statistically significant differences were observed in other measures.RTSA demonstrates better clinical efficacy compared to HA but is inferior to ATSA. It can be considered for expanding treatment options for elderly patients with 3 or 4‐part proximal humeral fractures, but it is not suitable for treating end‐stage shoulder arthritis and humeral head necrosis. Overall, the decision to use RTSA should be carefully evaluated based on the extent of the patient's rotator cuff injury. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to examine the radiographic and clinical outcomes of stemless reverse total shoulder arthroplasty (RTSA) after a minimum 2-year follow-up. Methods: Between July 2018 and March 2023, 50 patients underwent 50 stemless RTSA with the Lima component. Twenty-eight patients with a follow-up of more than 2 years were reviewed. The average age was 71.9 years (range, 61–85 years), and the average follow-up period was 2.2 years (range, 2.0–5.1 years). Bone marrow density of the proximal humerus was measured before RTSA. We evaluated preoperative and postoperative range of motion, clinical score, radiographic change, and postoperative complications. Results: Significant increases were observed postoperatively in forward flexion (112.0º–162.5º, P<0.01) and internal rotation (from L3 to T12 level, P<0.05). No changes were observed in external rotation (from 43.0º to 45.2º, P=0.762). The clinical scores improved for Korean Shoulder Scoring system (from 64 to 93, P<0.01) and American Shoulder and Elbow Surgeons score (from 17.5 to 27.3, P<0.01). Although radiolucent lines of less than 2 mm were observed in all cases, no osteolysis and loosening of the stemless humeral component was found. Scapular notching was observed in 18 cases (64.3%). Conclusions: Stemless RTSA showed good radiographic and clinical results after a minimum 2-year follow-up. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Background: To compare clinical outcomes following lateralized reverse shoulder arthroplasty (RSA) versus RSA with latissimus dorsi transfer (LDT) in patients with poor preoperative active external rotation (ER). Methods: We performed a systematic review per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We queried PubMed/Medline, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of RSA with LDT or lateralized RSA alone performed in patients with preoperative ER ≤0°. Our primary outcomes were active ER, active forward elevation (FE), Constant score, and the incidence of complications. Results: We included 12 RSA with LDT studies with 188 shoulders and 4 lateralized RSA without transfer studies with 250 shoulders. Mean preoperative ER in RSA with LDT was –14°, while mean preoperative ER in lateralized RSA alone was –11°. Lateralized RSA alone was associated with superior postoperative ER (28° vs. 22°, P=0.010) and Constant score (69 vs. 65, P=0.014), but similar postoperative FE (P=0.590). Pre- to postoperative improvement in ER and FE was similar between cohorts. RSA with LDT had a higher incidence of nerve-related complications (2.1% vs. 0%) and dislocation (2.8% vs. 0.8%) compared to lateralized RSA alone. Conclusions: Both RSA with LDT and lateralized RSA are reliable options to restore ER in patients with significantly limited preoperative ER. Our analysis suggests that lateralized RSA alone is superior to RSA with LDT in patients with either a medialized or lateralized implant design and confers a lower risk of complications, particularly nerve injury and dislocation. However, the addition of an LDT may still be indicated in certain patient populations with very severe ER loss. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Since the original Grammont design of a reverse shoulder arthroplasty there has been a trend to decrease inclination angle from 155° to 145 or 135°. Furthermore, lateralization on the glenoid side has been advocated. These changes decrease the risk for impingement between humerus and the inferior part of the glenoid (notching). These changes were also made to improve restoration of rotation. However, there is very little evidence that rotation has improved due to these changes. A negative effect of lateralization is that it increases the risk for glenoid loosening. Furthermore, the stress on acromion increases which may lead to more acromion or scapula spine fractures. More randomized studies are needed to define optimal design of a reverse shoulder arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Conventional techniques for the fixation of displaced proximal humeral fractures include the use of locking plates, intramedullary nailing, hemiarthroplasty and reverse shoulder replacement. Valgus-impacted fractures are a common subtype of proximal humeral fracture, but there are few publications concerning the outcomes of treatment. This study aims to review outcomes following an 'all-suture' technique for this fracture subtype without the use of transosseous sutures. Methods: All patients over the age of 18 who presented with 3- or 4-part valgus-impacted proximal humeral fractures and who underwent 'all-suture' repair at our centre were included. We reviewed their post-operative imaging and collected data on post-operative complications and patient-reported outcome measures. Results: We identified 15 patients who had undergone all-suture fixation. The cohort's mean age was 56. Eleven patients were female. Eight patients had 3-part fractures and seven patients had 4-part fractures. There were no major post-operative complications. All fractures united. The mean Oxford Shoulder Score was 43.7 and the mean Single Assessment Numerical Evaluation score was 85.9 at the final follow-up. Discussion: Our results suggest that all-suture fixation of proximal humeral fractures presents an attractive alternative to conventional techniques, whilst avoiding complications relating to metalwork implantation. [ABSTRACT FROM AUTHOR]

Purpose: Good initial fixation of glenoid component for reverse total shoulder arthroplasty (RTSA) relies on component placement and screw purchase in the scapula bone. This is especially difficult in an Asian population with small glenoid geometry. Optimal glenoid component roll angle and screw angulation to achieve the longest screws for best fixation has not been defined in the current literature. Methods: Computer 3D modelling of 133 scapulas with RTSA performed were analyzed to determine patient specific optimal glenoid roll angle (GRA) for the longest bi-cortical screws attainable. The cranial-caudal angle (CCA), anterior-posterior angle (APA) and lengths for the superior and inferior screws were measured. Validation testing using calculated average (CA) angles and rounded average (RA) angles to the nearest 5 degree were recomputed for each case to determine the bi-cortical screw lengths achievable. The CA and RA screw lengths were compared against patient specific modelling using paired-sample t-tests. Results: Average GRA was − 1.6°, almost perpendicular to the long axis of the glenoid and achieves an average bi-cortical screw length of 51.3 mm and 45.5 mm for the superior and inferior screws respectively. The CCA and APA were 9.1° cranial and 6.5° posterior for the superior screw and screw angulation of 11.2° caudal and 0.7° anterior for the inferior screw. Validation testing shows statistically shorter screw lengths in the CA and RA models compared to patient specific modelling (p < 0.01). Conclusion: Validation testing with average angles for GRA, CCA and APA demonstrates strong patient heterogeneity and anatomical variation. Despite this, screw lengths attainable in the RA group were > 38 mm with good safety profile. Surgeons may consider the additional use of navigation-assisted, or 3D printed patient specific instrumentation to optimize baseplate and screw configuration for RTSA. [ABSTRACT FROM AUTHOR]

Purpose: To report the radiological and clinical outcomes of non-vascularized coracoid process autografts used for glenoid reconstruction during revision shoulder arthroplasty. Material and method: This is a retrospective, monocentric study from January 2016 to October 2022 targeting patients treated with a coracoid bone graft for glenoid reconstruction during revision of shoulder arthroplasty. The primary outcome measures were coracoid graft union rate and graft-implant osseointegration. Secondary outcome measures included clinical and CT-scan identified radiological complications and functional outcomes as measured by the Visual Analog Scale (VAS), Range of Motion (ROM), Subjective Shoulder Value (SSV), Constant score (absolute and ponderate), and ASES score. Results: Fifteen patients (9 males, 6 females; mean age 66.9 years, range 38–85) were included. At a mean follow-up of 20.9 months (range 12–56 months), 93.3% achieved complete graft integration. One case of partial lysis without baseplate loosening was noted. Regarding range of motion, the mean forward elevation was 130° (range 90°-170°), external rotation at the side 25° (range 10°-40°), external rotation in 90° of abduction 45° (range 10°-80°), and internal rotation 52° (range 10–80°). The mean VAS for pain was 1.1 (range 0–8), mean SSV 67.3% (range 40–90%), mean ASES score 85.5 (range 65–98.3), mean Absolute Constant score 58.6 (range 21–83), and mean Ponderate Constant score 77.5% (range 28.8–110.7%). No neurological injuries were reported. Conclusion: Utilizing a non-vascularized coracoid graft during shoulder arthroplasty revision is a safe, reproducible, and time-efficient technique that demonstrated satisfactory osseointegration, implant stability, good functional results, and a low complication rate. [ABSTRACT FROM AUTHOR]

Background: Acromial stress fractures following reverse shoulder arthroplasty (RSA) have gained attention among specialized surgeons over the past decades craving answers regarding predisposing factors and technical aspects as how to avoid the complication. This study introduces the acetabularization index (AI) for the preoperative estimation of acromial bone loss attributed to acetabularization in cases of cuff tear arthropathy (CTA). Methods: The acromiohumeral interval (AHI), extent of acromial acetabularization (AA), acromial height (AH), and width of acetabularization (r) were measured on preoperative radiographs and two-dimensional computed tomography scans (2D CT) of patients who underwent RSA within the timeline 2019–2023 for CTA. The AI calculated AI % = AA mm ÷ AH mm . The CTA grade was determined according to the Hamada classification. The AI values on radiographs and 2D CT were compared by a Student's t-test. Possible correlation between the AI and AHI was investigated via Pearson's coefficient. The intraclass correlation coefficient (ICC) was employed to test the interobserver reliability among two independent testers. Results: The radiographs and 2D CT scans of thirty-three patients who underwent RSA were analyzed. The mean AHI, AH, AA, r, and AI values on radiographs were 5.5 ± 2 mm, 10 ± 2 mm, 2 ± 2 mm, 30 ± 4 mm, 16 ± 16%, respectively. On 2D CT, the corresponding mean values were 4.7 ± 2.5 mm, 10.8 ± 2.65 mm, 2.45 ± 2.35 mm, and 30 ± 4.5, and 22.3 ± 22%, respectively. There was a statistically significant difference between the AI values on radiographs and 2D CT (P =.000). The Pearson's correlation coefficient demonstrated a negative correlation between AI and AHI (r = − 0.33). Excellent reliability was observed by the ICC values for all parameters in both groups among two testers. Conclusion: The AI is a reliably measurable tool on radiographs and 2D CT scans; however, the measurements derived from radiographs vary significantly from CT based measurements due to projection restrictions. Grade IVB of the Hamada/Fukuda classification is associated with the highest AI values. Further research is warranted to assess the clinical utility of this index as a predictive tool for postoperative acromial stress fractures. [ABSTRACT FROM AUTHOR]

Background: 4-part proximal humerus fractures are complex injuries that are often associated with comminution of the greater tuberosity. The purpose of this study is to evaluate the functional outcomes of 4-part humerus fractures that are treated with reverse total shoulder arthroplasty (rTSA) and correlate these outcomes with the healing status of the greater tuberosity. Material and methods: A retrospective observational study was performed including 65 patients who underwent rTSA following a 4-part proximal humerus fracture. These patients were categorized into 3 groups according to the healing status of the greater tuberosity: patients with healed greater tuberosity in an anatomical position (group A, n = 43), patients with non-union of the greater tuberosity but in anatomical position (group B, n = 14), and patients with resorption or non-union of the greater tuberosity not in anatomical position (group C, n = 8). The Constant-Murley score and range of motion were recorded for each patient at 12 months postoperatively. The clinical and radiographical outcomes of the 3 groups were compared. Results: Patients with healed greater tuberosity (group A) had higher range of motion compared to patients with greater tuberosity migration or reabsorption (group C) regarding forward flexion (130° vs 80°, p < 0.001), abduction (110° vs 65°, p < 0.001) and external rotation (20° vs 10°, p = 0.004). However, no significant changes regarding forward flexion (130° vs 125°, p = 0.67), abduction (110° vs 100°, p = 0.60) and external rotation (20° vs 25°, p = 0.37) were noted between patients with healed greater tuberosity (group A) and those with non-united greater tuberosity that remained attached to the humeral prosthesis (group B). Similarly, Constant- Murley score was similar between patients of group A and group B (65.0 vs 61.5, p = 0.53), while it was higher in patients of group A compared to those of group C (65.0 vs 39.0, p = 0.053). Conclusions: The outcomes of this study indicate that reliable recovery regarding range of motion and functional status can be achieved in patients who undergo rTSA due to 4-part proximal humerus fractures, as long as the greater tuberosity remains in close proximity to the humeral prosthesis, even if it has signs of non-union with no continuity to the adjacent humerus. [ABSTRACT FROM AUTHOR]

Background: Despite the effectiveness of reverse total shoulder arthroplasty (RSA) and arthroscopic rotator cuff repair (ARCR) for treating massive rotator cuff tears (MRCTs), controversies remain in patients without glenohumeral osteoarthritis (GHOA). Purpose: To compare clinical outcomes of ARCR or RSA in patients with MRCT with high-grade fatty atrophy without GHOA. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective study on patients with MRCTs without GHOA and with grades 3 or 4 Goutallier muscle changes who underwent ARCR or RSA, with a minimum 2-year follow-up. Range of motion (ROM) and patient-reported outcomes (PROs) were collected—including visual analog scale for pain, American Shoulder and Elbow Surgeons score, Veterans Rand 12-Item Health survey, and Subjective Shoulder Value. Postoperative results were compared based on rotator cuff tendon healing in the ARCR group. Results: A total of 81 patients met the study criteria—56 underwent ARCR and 25 underwent RSA. Patients in the RSA (age, 71.7 ± 7.7 years) group were older than those in the ARCR (age, 66.7 ± 7.4 years) group (P =.01) and more likely to have pseudoparalysis (52% vs 21.4%; P =.016). The mean follow-up for the ARCR and RSA groups was 56.5 ± 19 months and 36.1 ± 7.6 months, respectively (P <.001). The rate of patients with ≥2 tendons with grade 3 or 4 changes was higher in the RSA group compared with the ARCR group: 96% versus 47% (P <.001). PROs significantly improved after surgery in both groups (P <.05). Postoperative forward flexion (FF) and internal rotation were higher after ARCR compared with RSA—144°± 22° versus 113°± 25° and L3 ± L4 versus S1 ± S2, respectively (P <.001 and P =.002, respectively). Also, 31 of the rotator cuff repairs (55%) healed. PROs were similar between the healed and unhealed ARCR groups, with the only difference observed in postoperative FF—150°± 18° in the healed group versus 136°± 26° in the unhealed group (P =.044). Conclusion: Both ARCR and RSA improved functional outcomes in patients with MRCT without GHOA. While healing was moderate after ARCR, the postoperative ROM was greater after ARCR compared with RSA in appropriately selected patients. Moreover, healed rotator cuffs demonstrated improved postoperative FF compared with unhealed repairs. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effect of three-dimensional (3D) volumetric humeral canal fill ratios (VFR) of reverse shoulder arthroplasty (RSA) short and standard stems on biomechanical stability and bone deformations in the proximal humerus. Methods: Forty cadaveric shoulder specimens were analyzed in a clinical computed tomography (CT) scanner allowing for segmentation of the humeral canal to calculate volumetric measures which were verified postoperatively with plain radiographs. Virtual implant positioning allowed for group assignment (VFR < 0.72): Standard stem with low (n = 10) and high (n = 10) filling ratios, a short stem with low (n = 10) and high filling ratios (n = 10). Biomechanical testing included cyclic loading of the native bone and the implanted humeral component. Optical recording allowed for spatial implant tracking and the quantification of cortical bone deformations in the proximal humerus. Results: Planned filling ratios based on 3D volumetric measures had a good-to-excellent correlation (ICC = 0.835; p < 0.001) with implanted filling ratios. Lower canal fill ratios resulted in significantly higher variability between short and standard stems regarding implant tilt (820 N: p = 0.030) and subsidence (220 N: p = 0.046, 520 N: p = 0.007 and 820 N: p = 0.005). Higher filling ratios resulted in significantly lower bone deformations in the medial calcar area compared to the native bone, while the bone deformations in lower filling ratios did not differ significantly (p > 0.177). Conclusions: Lower canal filling ratios maintain dynamic bone loading in the medial calcar of the humerus similar to the native situation in this biomechanical loading setup. Short stems implanted with a low filling ratio have an increased risk for implant tilt and subsidence compared to high filling ratios or standard stems. [ABSTRACT FROM AUTHOR]

Copyright of Obere Extremitat is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Reverse total shoulder arthroplasty (RTSA) is commonly performed to reduce pain and restore shoulder function in patients with severe shoulder conditions. While most patients experience significant pain relief and functional improvement following surgery, a subset of patients continue to report persistent pain even two years postoperatively. The aim of this study was to identify both modifiable and non-modifiable preoperative factors that contribute to the risk of persistent postsurgical pain after RTSA. By understanding these factors, clinicians can better anticipate which patients are at higher risk and develop tailored preoperative and postoperative pain management strategies to improve overall outcomes. Methods: In this retrospective cohort study, 703 patients with complete data undergoing primary RTSA performed between 2011 and 2022 were analyzed. Persistent postsurgical pain was defined as a pain score ≥ 3 on a numeric rating scale. Multivariable regression models were used to identify patient-related and disease-related predictors of persistent postsurgical pain. Results: The cohort comprised 445 women (63%) and 258 men (37%) with a mean age of 74 ± 8 years at the time of surgery. Persistent postsurgical pain was reported by 18% of patients. Preoperative pain scores averaged 6.0 ± 2.5 on the NRS scale, which decreased to 1.2 ± 1.8 postoperatively. Key predictors included higher preoperative pain levels (β = 0.10, p < 0.001), worse preoperative QuickDASH scores (β = 0.09, p = 0.002), mild symptoms of anxiety or depression (β = 0.52, p = 0.001), prior contralateral TSA surgery (β = 0.34, p = 0.018) and greater number of previous ipsilateral shoulder surgeries (β = 0.44, p < 0.001). In contrast, patients with rheumatoid arthritis (β = − 0.85, p < 0.001) or primary osteoarthritis (β = − 0.82, p < 0.001) experienced lower pain levels. Conclusion: Our study offers important insights into the predictors of persistent postsurgical pain two years after RTSA. Key factors, including higher preoperative pain scores, poor mental health, elevated QuickDASH scores, prior contralateral TSA surgery and a history of prior ipsilateral shoulder surgeries, were identified as significant risk indicators for persistent postsurgical pain. [ABSTRACT FROM AUTHOR]

Background: While shared decision making is a cornerstone of orthopedic care, orthopedic surgeons face challenges in tailoring their advice and expectation management to individual shoulder arthroplasty patients due to the lack of systematically summarized evidence-based knowledge. This systematic review aims to provide an overview of current knowledge on independent predictive effects of patient-related factors on functional and pain-related outcomes after shoulder arthroplasty. Methods: We included longitudinal cohort studies including patients receiving total or reverse shoulder arthroplasty or hemiarthroplasty for primary osteoarthritis or cuff tear arthropathy. Studies with only univariable analyses were excluded. MEDLINE, Embase, and CINAHL databases were last searched on June 27, 2023. Risk of bias was evaluated using the QUIPS tool. For the analyses, we divided outcomes into three domains (Functional Recovery, Pain, and Functional Recovery & Pain) and four time points (short term, medium-short term, medium-long term and long term). When appropriate, meta-analyses were conducted to pool regression coefficients or odds ratios. Otherwise, results were summarized in a qualitative analysis. We used the GRADE approach to rate the certainty of the evidence. Results: Thirty-three studies analyzing over 6900 patients were included; these studied 16 PROMs and 52 prognostic factors. We could perform meta-analyses for six combinations of prognostic factor, domain, and time point. Only the meta-analysis for medium-long term poor ASES scores indicated worse outcomes for previous shoulder surgery (OR (95%CI) of 2.10 (1.33–3.33)). The majority of reported factors showed unclear or neutral independent effects on functional outcomes. Conclusions: Methodological heterogeneity and selective/incomplete reporting prevented us from pooling most results, culminating in a largely qualitative analysis. Depression, preoperative opioid use, preoperative ASES and SST scores, surgery on the dominant side, previous surgery, male gender, no. of patient-reported allergies, back pain, living alone, CTA vs OA, diabetes, and greater preoperative external ROM predicted neutral to worse or worse outcomes. In contrast, higher electrical pain threshold on the operative side, OA/RCA vs other diagnosis, and private insurance vs Medicaid/Medicare predicted neutral to better or better outcomes. These results can help orthopedic surgeons tailor their advice and better manage expectations. Systematic review registration: PROSPERO CRD42021284822. [ABSTRACT FROM AUTHOR]

Purpose/AimMaterials and MethodsResultsConclusionsMetabolic disorders are risk factors for rotator cuff injuries, which suggests that the rotator cuff is sensitive to local metabolic fluctuations. However, the link between the metabolic microenvironment and pathologic features of acute tear versus chronic degeneration is currently unknown. The overarching goal of this study was to evaluate alterations in tendon metabolite profiles following acute tear or chronic degeneration of the rotator cuff. We hypothesized that injury types (acute tear vs. chronic degeneration) would result in distinct metabolite profiles relative to clinically unaffected tendon controls.We utilized untargeted metabolomics to identify pathways that were altered at the time of rotator cuff repair (RCR; acute tear) or reverse total shoulder arthroplasty (rTSA; chronic degeneration) relative to total shoulder arthroplasty controls (TSA; tendon clinically unaffected).Acute tears to the rotator cuff were associated with an overall decrease in tendon metabolites. This global decrease was primarily associated with glycolic acid and decreased tricarboxylic acid (TCA) cycle activity. Conversely, chronic tendon specimens from patients undergoing rTSA showed an overall increase in metabolites. Most notably, chronic injury was associated with increased levels of multiple amino acids including alanine, aspartate, lysine, and proline.Overall, this study demonstrates that distinct metabolite profiles are associated with injury types, and that therapeutic strategies should address both cellular and matrix components regardless of injury induction. The specific pathways identified paired with validated, established, treatment methods may serve as novel therapeutic targets for patients who suffer from rotator cuff injuries. [ABSTRACT FROM AUTHOR]

Background: Various fracture-specific reverse shoulder arthroplasty (RSA) systems exist on the market. We set out to examine whether the type of prosthesis used and the means of fixation (cemented or non-cemented) influenced the rate of tuberosity healing or the functional outcome of the operation. Methods: This retrospective cohort multicenter study included 146 patients who underwent RSA for an acute three- or four-part proximal humerus fracture and had a minimum follow-up of one year. Six fellowship-trained surgeons at two different centers performed all operations. The implants were either Tornier Aequalis or Depuy Delta Xtend, both fracture-specific Grammont-style systems. Results: The mean age ± standard deviation (SD) was 76 ± 7 years, and 83% of patients were female. The mean ± SD follow-up time was 30 ± 31 months. The Aequalis prosthesis was used in 82 patients (56%), and the Delta Xtend in 64 patients (44%). A total of 105 RSAs (72%) were cemented. Tuberosity healing rate was similar for the two implant systems (71% Aequalis vs. 82% Delta Xtend, p = 0.15) and for the cemented or non-cemented, respectively (73% cemented vs. 83% non-cemented, p = 0.22). There was no significant difference in the motion and functional outcomes between the two implant systems in this study. Conclusions: RSA for complex PHF in the elderly has similar short-term results, regardless of the type of fracture-specific implant or the fixation technique (cemented vs. cementless). [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions Proximal humeral fractures (PHFs) show a high incidence in aged patients. While nondisplaced fractures achieve good results by conservative treatment, surgical procedures are discussed controversially. Next to open reduction and internal fixation (ORIF), the primary use of reverse shoulder arthroplasty (RSA) has become increasingly important. The aim of this study was to investigate the clinical function, activities of daily living (ADL), as well as pain assessment in patients with PHFs, treated by ORIF or RSA.A retrospective comparison study was assessed. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF or RSA of the proximal humerus, were included in this study. Pain was measured by numeric rating scale (NRS). ADL were obtained by Katz‐Index and SF‐12. Moreover, shoulder function was assessed using the Oxford Shoulder Score (OSS). The maximum range of motion (ROM) was also recorded. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF (Figure or RSA of the proximal humerus) were included in this study. For statistical analyses, Student's t‐test, Wilcoxon test, and Chi‐Quadrat test were used. Statistical significance was indicated with p < 0.05.Totally 34 patients with an average age of 76.6 years were included. Surgical treatment was performed on average 5.2 days after diagnosis, differing significantly between the two groups (RSA/ORIF: 6.9/3.5 days) The operation time of RSA (97 min) was significantly longer than for ORIF (78 min). Pain assessment, as well as the Katz‐Index and the SF‐12, showed no significant differences. Moreover, clinical shoulder function showed no significant discrepancies between the two surgical techniques.Aged patients with PHFs treated with RSA display similar results regarding clinical function, ADL as well as pain perception compared with ORIF. However, revision surgery rate was lower in patients who underwent RSA. Thus, the surgical treatment of PHFs by RSA represents an excellent alternative, especially with regard to an aging patient population. [ABSTRACT FROM AUTHOR]

The treatment of proximal humeral fractures is controversial, and operative treatment is increasing despite sparse evidence to support any surgical method over another. We present the 5-year results of the DelPhi (Delta-PHILOS) trial, in which the hypothesis was that reverse total shoulder arthroplasty (RTSA) yields better clinical results compared with open reduction and internal fixation (ORIF). The DelPhi trial was a multicenter single-blinded randomized controlled trial comparing RTSA versus ORIF for the treatment of displaced AO/OTA type-B2 and C2 proximal humeral fractures in patients 65 to 85 years of age. One hundred and twenty-four patients were allocated to RTSA (64 patients) or ORIF (60 patients). The primary outcome was the Constant score, and secondary outcomes included the Oxford Shoulder Score, radiographic measurements, and quality of life. The results were reported as the mean difference between the groups, with the 95% confidence interval (CI). The mean age was 75 years, and 90% of the patients were female. Overall, 65 of the 124 patients were available at a minimum of 5 years. The mean Constant score was 71.7 (95% CI, 67.1 to 76.3) for the RTSA group, compared with 58.3 (95% CI, 50.6 to 65.9) for the ORIF group, representing a significant difference of 13.4 (95% CI, 5.2 to 21.7) in favor of RTSA (p = 0.002). Among patients with type-C2 fractures, the mean Constant score was 73.3 (95% CI, 67.5 to 79.2) for the RTSA group and 56.0 (95% CI, 47.4 to 64.7) for the ORIF group, representing a significant difference of 17.3 (95% CI, 7.5 to 27.0) in favor of RTSA (p = 0.001). Patients with type-B2 fractures demonstrated a nonsignificant difference of 8.1 (95% CI, −7.3 to 23.3) in favor of RTSA (p = 0.29). Patients 65 to 74 years of age showed a significant mean difference of 15.7 (95% CI, 4.9 to 26.7) in favor of RTSA (p = 0.006), whereas patients 75 to 85 years of age showed a nonsignificant difference of 10.8 (95% CI, −3.0 to 24.6) in favor of RTSA. In the present study, RTSA was superior to plate fixation for displaced AO/OTA type-B2 and C2 fractures in elderly patients at 5 years. Patients 65 to 74 years of age and patients with type-C2 fractures benefited the most. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background Acquired acromial compromise, including thinning (less than 30% of the normal acromion) or fragmentation resulting from acromiohumeral impingement or previous acromioplasty, is a concern in reverse shoulder arthroplasty (RSA). This condition may lead to shoulder pain and difficulties in arm elevation because of acromial insufficiency fracture. Questions/purposes (1) Do patients with acromial compromise (thinning less than 30% of normal acromion or fragmentation) have worse functional outcome scores, ROM, and strength after RSA compared with patients without acromial compromise? (2) Are patients with acromial compromise at a higher risk of complications such as acromial insufficiency fracture after RSA? (3) Do patients who develop acromial insufficiency fracture have predisposing associated factors and worse clinical outcomes? Methods Between January 1, 2016, and December 31, 2020, we treated 398 patients with RSA, and all patients were considered potentially eligible for this study. Our clinic is part of the orthopaedic department within a tertiary general hospital, serving patients from across the country. Among them, 49% (197 of 398) of patients were excluded for the following reasons: 8% (31 of 398) because of proximal humerus fracture, 5% (19 of 398) because of osteonecrosis, 9% (35 of 398) because of previous infective arthritis, 5% (18 of 398) because of a deformed shoulder, 4% (14 of 398) because of poor general condition after surgery, 3% (12 of 398) because of death, and another 17% (68 of 398) were lost before the minimum study follow-up, leaving 51% (201 of 398) for analysis. A preoperative acromial compromise was defined as follows: (1) thinning of the acromion (< 3 mm), which means a thickness of less than 30% of the normal acromion thickness (8 to 9 mm), and (2) acromial fragmentation. Acromial thickness was measured using a CT scan. The middle portion of the anterolateral acromion, situated lateral to the distal end of the clavicle, was crosschecked using the axial view. Measurements were subsequently performed from both coronal and sagittal views. In all, 29 patients with acromion compromise and 172 without acromion compromise met the inclusion and exclusion criteria. There was no differential loss to follow-up before 2 years between patients with and without acromial compromise in this study (36% [16 of 45] versus 23% [52 of 224]; p = 0.12). We matched patients using propensity score, pairing them in a 1:3 ratio based on gender, age, bone mineral density, diagnosis, previous rotator cuff repair surgery, subscapularis repair or latissimus dorsi transfer performed during surgery, the type of prosthesis used, and follow-up duration. Twenty-three patients with acromial compromise (acromion compromised group) and 69 patients without acromial compromise (normal control group) were matched; the mean 6 SD duration of follow-up was 40 6 22 months in those with acromial compromise and 43 6 19 months the in normal control group. Pre- and postoperative functional outcome scores, ROM, and shoulder strength were compared. Shoulder scaption refers to lifting the arm in the scapular plane, and scaption strength was measured by applying upward force with the arm at 90° while seated, pushing it as far as possible and measured using a handheld myometer. Complications, including acromial insufficiency fracture, scapular notching, dislocation, periprosthetic infection, and overall risk of complication, were analyzed. Acromial insufficiency fracture was diagnosed based on clinical and radiological findings. Clinically, sudden pain and tenderness at the acromion along with reduced shoulder elevation raised acromial insufficiency fracture suspicion. Radiologically, acromion tilt on plain radiograph or fracture line on coronal CT view confirmed diagnosis of acromial insufficiency fracture. Results Comparing both groups, patients with a compromised acromion had no difference in American Shoulder and ElbowSurgeons scores (60612 versus 64612; mean difference -4 [95% CI -11 to 2]; p = 0.16), Constant scores (48 6 10 versus 54 6 12; mean difference -6 [95% CI -13 to 0]; p = 0.06), forward flexion degree (125 6 24 versus 130 6 21; mean difference -5 [95% CI -16 to 6]; p = 0.36), and scaption strength (563 versus 663; mean difference -1 [95% CI -3 to 0]; p = 0.13). Having acromial compromise was not associated with increased risk of overall complications (30% [7 of 23] versus 19% [13 of 69], relative risk 2 [95% CI 1 to 4]; p = 0.26). However, the only complication that was higher in the acromial compromised group was infection (13% [3 of 23] versus 0% [0 of 69], relative risk not available; p = 0.01). Only the lateralized glenoid prosthesis demonstrated negative association with the acromial insufficiency fracture occurrence; no other factors showed an association. The use of lateralized glenoid prostheses was not observed in patients with acromial insufficiency fracture (0% [0 of 7] acromial insufficiency fracture versus 39% [33 of 85] no acromial insufficiency fracture, relative risk 0 [95% CI 0]; p = 0.047). Conclusion In patients with acquired acromial compromise--such as thinning or fragmented acromion because of advanced cuff tear arthropathy or previous acromioplasty--primary RSA resulted in no different functional outcome score, ROM, shoulder strength, and overall complications compared with patients without acromial compromise. Our findings suggest that a thin or fragmented acromion may not necessarily be exclusion criteria for RSA, potentially aiding surgeons in their decision-making process when treating these patients. However, one of the major complications, postoperative infection, is more frequently observed in patients with acquired acromial compromise. Pre- and postoperative caution would be necessary to prevent and detect infection even when short-term outcomes are favorable in this study. Further studies with large cohorts and long-term follow-up durations are needed. Level of Evidence Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Reverse shoulder arthroplasty (RSA) has become a widely used procedure since its introduction in the 1980s, and is currently used to treat a wider range of conditions than its original indication. The original Grammont-style RSA revolutionized shoulder arthroplasty but had several limitations, including scapular notching and reduced rotational motion. This review discusses the evolution of RSA design, particularly the development of a lateralized center of rotation constructs, which aims to improve all the disadvantages associated with the Grammont-style design and more closely reproduce the native anatomy in order to improve patient outcomes in an expanded context of pathologies. [ABSTRACT FROM AUTHOR]

Background/Objectives: To investigate clinical and functional outcomes of patients undergoing reverse total shoulder arthroplasty (RTSA) using a rehabilitation protocol of either 4 or 6 weeks of immobilization. Methods: This comparative study analyzed a consecutive patient cohort that underwent RTSA in a single institute from January 2021–February 2023. Patients were assigned to groups according to the duration of postoperative immobilization and were followed up for a minimum of one year. Patient demographics, range of motion (ROM), functional outcomes using the Simple Shoulder Test (SST) and the American Shoulder and Elbow Score (ASES) as well as postoperative complications were recorded. The minimum clinically important difference (MCID) was used to assess whether the differences between the groups in SST, ASES, SWB, and VAS were clinically relevant. Results: Sixty patients met the inclusion criteria (35 patients in the 6-week immobilization group (6 WG) and 25 patients in the 4-week immobilization group (4 WG)) and were available for the total follow-up period. Similar baseline demographics were observed between the groups. Active ROM significantly improved for both groups, with abduction and forward flexion improving the most. In terms of functional outcomes, significant improvement (p < 0.001) was demonstrated for both groups (ASES, SST, VAS, and SWB). However, patients in the 4 WG reached significantly better results in VAS and SWB at 6 weeks and 3 months, as well as in ASES 3 months postoperatively, whereas both groups leveled off at the end of the follow-up period after 1 year. Taking into account the MCID, these differences for ASES at 3 months, as well as VAS and SWB at 6 weeks and 3 months postoperatively, were significant. Surprisingly, there were no differences between the groups over the entire follow-up period in terms of the SST. Conclusions: The author's findings suggest faster clinical recovery at 6 weeks and 3 months in patients undergoing postoperative immobilization of 4 weeks compared to 6 weeks following RTSA. However, clinical and functional outcomes were equal for 4 WG and 6 WG at one year follow up. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review and meta-analysis compared clinical outcome measures in patients undergoing reverse shoulder arthroplasty (RSA) for proximal humerus fracture (PHF) with healed versus non-healed greater tuberosity (GT). Methods: We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines querying PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane for studies that stratified results by the GT healing status. Studies that did not attempt to repair the GT were excluded. We extracted and compared clinical outcomes including postoperative forward flexion (FF), external rotation (ER), internal rotation (IR), Constant score, and complications and revision rates. Results: Of the included patients, 295 (78.5%) demonstrated GT healing while 81 did not (21.5%). The healed GT cohort exhibited increased postoperative FF (P <.001), ER (P <.001), IR (P =.006), and Constant score (P =.006) compared to the non-healed GT cohort. The overall dislocation rate was 0.8% with no study differentiating GT status of dislocation cases. Conclusion: Healing of the GT after RSA for PHF yields improved postoperative range of motion and strength, whereas patient-reported pain and function were largely not affected by GT healing indicating merit to RSA for PHF regardless of the likelihood of the GT healing. [ABSTRACT FROM AUTHOR]

Purpose: A retrospectively analyze of instability after RSA in terms of aetiology, treatment and final functional outcome. Methods: A bicentric retrospective study of 31 patients (mean age 67.6 years; 42–83) treated for RSA instability using RSA Arrow System (FH Orthopedics, Mulhouse, France), mean follow-up 41months (range 12–158). Aetiologies for dislocation were evaluated using a previously described classification system for RSA instability. Actions performed during the Revision Surgeries were analyzed and grouped into five categories. Clinical outcome measures included range of motion, SSV, VAS, Constant-Murley scores, satisfaction level and recurrence of instability. Results: The most frequent aetiology for RSA instability was loss of compression (18), followed by impingement (8) and loss containment (5). Total RSA revision (bipolar procedure) involving both distalization and lateralization occurred in 13 instances. Isolated distalization through the humerus was performed in ten patients and Isolated lateralization through the glenoid in three patients. Three cases of components exchange due to mechanical failure were noted. Bone graft was used in nine instances. Three patients (10%) suffered recurrent instability following Revision Surgery and required an additional stabilizing procedure. At final follow-up all 31 RSA were reported as stable with a mean VAS of 1.1, SSV 54.5%, constant score 48.3, constant ponderate 74.9%. Conclusion: The management of unstable RSA represent a challenge that can be successfully overcome with a revision surgery with compromised functional results. Loss of compression was the most common cause for primary and recurrent RSA instability that were treated principally with bipolar revisions involving component lateralization and distalization. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to observe the effects of changing humeral tray thickness on the resultant of intraoperative glenohumeral joint loads using a load-sensing system (LSS). Methods: An rTSA was performed on fresh frozen full-body cadaver shoulders by using an internal proprietary LSS on the humeral side. The glenohumeral loads (Newtons) and the direction of the resultant force applied on the implant were recorded during four standard positions (External rotation, Extension, Abduction, Flexion) and three "complex" positions of Activity Daily Life ("behind back", "overhead reach" and "across chest"). For each position, the thickness was increased from 0 to 6 mm in a continuous fashion using the adjustment feature of the humeral system. Each manoeuvre was repeated three times. Results: All shoulder positions showed a high repeatability of the glenohumeral load magnitude measured with an intra-class correlation coefficient of over 0.9. For each position, we observed a strong but no linear correlation between humeral tray thickness and joint loads. It was a cubical correlation (rs = 0,91) with a short ascending phase, then a plateau phase, and finally a phase with an exponential growth of the loads on the humeral implant. In addition, an increase in trail-poly thickness led to a recentering of force application at the interface of the two glenohumeral implants. Conclusion: This study provides further insight into the effects of humeral implant thickness on rTSA glenohumeral joint loads during different positions of the arm. Data obtained using this type of device could guide surgeons in finding the proper implant balance during rTSA. [ABSTRACT FROM AUTHOR]

Background: The incidence of primary reverse total shoulder arthroplasty (rTSA) and the prevalence of obesity have increased in the United States. Despite this, the literature assessing the effect of morbid obesity (body mass index≥40 kg/m2) on perioperative surgical outcomes remains inconsistent. Methods: A retrospective review of consecutive elective primary rTSA cases from January 2016 through September 2023 at a single tertiary referral center was performed. All cases involved a short-stem humeral component and screw-in glenoid baseplate from the same implant manufacturer. Surgical and patient demographic data were collected. Morbidly obese patients were propensity matched at least 1:1 with non-morbidly obese patients based on age, gender, modified 5-item frailty index score, adjusted Charlson comorbidity index score, and 12-month preoperative emergency department (ED) visit. Regression analysis was utilized to assess the relationship between morbid obesity and operative time, length of stay, intraoperative total blood volume loss, surgical postoperative complications, in-hospital medical complications, disposition, and 90-day ED return and readmission. Results: There were a total of 175 short-stem rTSA cases performed with a median age of 71 years (interquartile range: 66, 76), of which 19 (10.9%) had a body mass index ≥40 kg/m2. These 19 patients were propensity score matched to 41 non-morbidly obese patients (9 at 1:3, 4 at 1:2, and 6 at 1:1). There were no significant differences between the groups with regard to intraoperative total blood volume loss, operative time, need for transfusion, hospital length of stay, discharge disposition, prevalence for 90-day return to ED, or unplanned 90-day readmission. Conclusion: Morbid obesity should not be considered an absolute contraindication for elective rTSA, particularly in patients who have undergone appropriate preoperative medical clearance.

Background: Proximal humeral bone deficiency in revision shoulder arthroplasty is an emerging and challenging problem as the use of reverse shoulder arthroplasty (RSA) increases. This paper presents a technical note discussing our detailed preoperative planning steps, surgical techniques, and their rationale in carrying out the use of an allograft prosthetic composite (APC) to address proximal humeral bone deficiency in revision RSA. The outcomes of this technique are also presented. This paper also presents a systematic review to further discuss the existing literature on RSA with APCs. Methods: The preoperative surgical planning and the surgical technique employed to execute proximal humeral reconstruction using APC during revision arthroplasty are discussed in the technical note. The preliminary clinical and radiological results of five patients who underwent revision shoulder arthroplasty with proximal humeral reconstruction using APCs are presented. The PRISMA guidelines were followed to perform the systematic review. A systematic search using PubMed, Embase, and Cochrane databases was conducted. All studies involving RSA and APCs were pooled, and the data were extracted and analyzed. Results: A total of 14 studies were eligible for inclusion in the systematic review, with a total of 255 patients and a mean follow-up of 57 months. All studies in the systematic review and the patients included in the author's case series showed improvements in the level of pain, range of motion, function, and satisfaction. Graft incorporation in the systematic review was 84%. Conclusions: Based on the available literature and the results of our case series, the use of an APC construct is a viable option for proximal humeral bone deficiency in revision shoulder arthroplasty. [ABSTRACT FROM AUTHOR]

Objective: Although the indications for reverse shoulder arthroplasty (RSA) are expanding, an improvement in muscle strength in each patient following RSA remains unclear. The objective was to investigate whether or not improvement in muscle strength for shoulder elevation in patients who underwent RSA was influenced by pre- or postoperative deltoid muscle stiffness measured using shear wave elastography (SWE). Methods: Sixty-five patients who underwent RSA over a 12-month follow-up period were included. Patient characteristics and clinical and radiologic measurements were recorded. Preoperatively and at 3, 6, 9, and 12 months after surgery, deltoid muscle stiffness and muscle strength for scapular-plane abduction were sequentially measured using SWE and a portable dynamometer. In each quarterly period (3–6, 6–9, and 9–12 months), patients were assessed for an improvement in muscle strength and separated into two groups: improved and non-improved. To assess the risk of lack of improvement in each quarterly period, the variables were compared between the groups. Results: Improvement in muscle strength was observed in 52 patients (80%) at 3–6 months, 46 patients (71%) at 6–9 months, and 39 patients (60%) at 9–12 months. Notably, SWE measurements at the beginning of each period showed significantly greater values in the non-improved group than in the improved group during the subsequent quarterly period. A receiver operating characteristic (ROC) curve analysis suggested that SWE values >45.1–50.0 kPa might be associated with a lack of muscle strength improvement over 3 months with 73–87% specificity and 73–85% sensitivity. Conclusions: Our study demonstrated that increased deltoid muscle stiffness negatively correlated with an improvement in muscle strength following RSA. According to our results, a postoperative assessment with SWE may be useful for not only improving muscle strength after RSA but also facilitating postoperative improvement by preventing excessive stiffness in the deltoid muscle. [ABSTRACT FROM AUTHOR]

The document "Abstracts for the 36th Annual Scientific Meeting BESS 2024" showcases a range of research studies focusing on shoulder and elbow conditions. Topics include the effectiveness of total elbow arthroplasty surveillance, comparisons of different pain measures, outcomes of various surgical procedures, and the benefits of brachial plexus blocks. Other studies delve into biomechanics, virtual reality interventions, and functional assessments. The document also highlights the achievements of BESS 2024 Prize winners for their exceptional contributions to orthopaedic research and patient care. [Extracted from the article]

Background: To investigate the clinical outcomes of reverse shoulder arthroplasty (RSA) in patients with rheumatoid arthritis (RA), using patient-reported outcome (PRO) measures, and compare the finding to those in patients with osteoarthritis (OA). Materials and Methods: The study included 24 patients (11 with RA and 13 with OA) who underwent primary RSA with a minimum of 2 years of follow-up. Clinical data, including range of motion (ROM; flexion, abduction, external rotation, and internal rotation) and PRO measures (Shoulder36 questionnaire and disability/symptom scale in Quick Disability of the Arm, Shoulder, and Hand [QuickDASH-DS]), were assessed. Results: ROM, Shoulder36 scores (except sports ability scores), and QuickDASH-DS in the RA group, and ROM (expect internal rotation), Shoulder36 scores (except general health scores), and QuickDASH-DS scores in the OA group were significantly improved at follow-up than the preoperative state. At follow-up, there was no significant difference found in any of the variables between the RA and OA groups (flexion: 116.4° vs. 133.1°, P = 0.102; abduction: 100.5° vs. 120.8°, P = 0.159; pain score in Shoulder36: 1.8 vs. 2.1, P = 0.397; ROM score in Shoulder36: 2.1 vs. 2.1, P = 0.578; muscle strength in Shoulder36: 1.8 vs. 1.9, P = 0.680; QuickDASH-DS score: 48.1 vs. 32.7, P = 0.059). Conclusion: The mid-term clinical results after RSA were comparable between patients with RA and those with OA. RSA can be considered the surgical treatment of shoulder in both patients with RA and those with OA. [ABSTRACT FROM AUTHOR]

Background: The increasing incidence of reverse total shoulder arthroplasties (RTSA) has led to an increase in revision surgery. We aimed to compare patients undergoing re-revision RTSA to a matched cohort undergoing first-revision RTSA. Methods: A retrospective review of all revision RTSAs was performed at a single institution. Sixteen shoulders that underwent re-revision RTSA were matched 1:3 to shoulders that underwent revision RTSA with a minimum two-year follow-up. Outcome scores including the American Shoulder and Elbow Surgeons Shoulder Score (ASES), Short-Form 12 (SF-12), Shoulder Pain and Disability Index (SPADI), and Simple Shoulder Test (SST) scores, range of motion (ROM), and improvement from preoperative to postoperative outcomes after re-revision RTSA were assessed. Additionally, postoperative outcomes after re-revision RTSA were compared to patients that underwent first revision RTSA and subsequently compared to the minimal clinically important difference (MCID) values for the outcome scores and ROM measurements assessed. Results: Sixteen shoulders that underwent re-revision RTSA and 78 revision RTSAs met the final inclusion criteria to be included in this study. Significant improvement from preoperative to postoperative re-revision RTSA was seen in the ASES score (p = 0.046), SPADI score (p = 0.044), SST (p = 0.008), abduction (p = 0.016), and elevation (p = 0.025), but not the SF-12 score (p = 0.396), external rotation (p = 0.449), or internal rotation (p = 0.451). Outcomes after revision RTSA were found to be superior to outcomes after re-revision RTSA for all outcome scores (ASES p = 0.029, SF-12 p = 0.018, SPADI p = 0.003) except the SST score (p = 0.080) and all ROM measures (p > 0.05 for all). Internal rotation was equivalent postoperatively between both groups. From preoperative to postoperative re-revision RTSA, the mean improvement exceeded the MCID for the SST score, abduction, forward elevation, and external rotation. When comparing postoperative revision RTSA to postoperative re-revision RTSA, the mean difference between revision and re-revision RTSA exceeded the MCID for the SPADI score and external rotation. The complication rate was 19% in shoulders undergoing first revision and 41% in shoulders undergoing re-revision RTSA. Conclusion: Patients undergoing re-revision RTSA receive improvement in clinical outcomes, but do not achieve outcomes comparable to those achieved after first revision RTSA. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to describe outcomes of patients undergoing reverse total shoulder arthroplasty (rTSA) using a patient-specific, custom glenoid component to address severe glenoid deficiency. Methods: Retrospective chart review identified patients at a single institution undergoing rTSA using the glenoid vault reconstruction system (VRS) between 2017 and 2022. Radiographic evaluation, range of motion and patient-reported outcome (PRO) measures, complications, and re-operations were assessed. Results: Fourteen shoulders were included. There was 100% implant survivorship of the glenoid baseplate at mean follow-up of 26.6 months. Mean range of motion improved in forward elevation (62–106 degrees), abduction (41–100 degrees), and external rotation (11–36 degrees). In 7 of 13 patients available for PRO collection, the mean final Visual Analog Pain Scale (VAS) score was 1.29, Single Assessment Numeric Evaluation (SANE) score was 72.14, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score was 77.14, and Penn Shoulder score was 72.26. Conclusions: Use of this custom glenoid resulted in encouraging clinical and radiographic outcomes, with no failures in implant survivorship seen at early follow-up. Larger prospective studies with longer-term follow-up should be undertaken in order to better determine the efficacy and longevity of this implant. Study Design: Retrospective case series; Level of evidence, 4. [ABSTRACT FROM AUTHOR]

Background: Reverse shoulder arthroplasty (RSA) is an established operative treatment for failed rotator cuff repair (RCR) that may not be amenable to revision repair. The purpose of this meta-analysis is to evaluate the clinical outcomes for patients undergoing RSA following prior failed RCR compared with patients without prior RCR undergoing primary RSA. Methods: A systematic search of articles in Pubmed, EMBASE and The Cochrane Library databases was carried out according to PRISMA guidelines. Comparative studies assessing outcomes of RSA after failed RCR versus primary RSA were included. Results: Seven studies with 2149 total patients were included; 760 patients had a prior RCR and 1389 patients did not have a prior RCR. Prior failed RCR resulted in significantly lower postoperative ASES scores (mean difference [MD], −8.31 95% confidence interval [CI] −10.96, −5.66), less forward flexion (MD, −6.71 95%CI −11.75, −1.67), and higher VAS pain scores (MD; 0.85, 95% CI 0.47, 1.22) when compared to primary RSA. There were no significant differences in external rotation, complications rate, or rate of revision. Conclusion: This study found that failed RCR prior to RSA was associated with lower functional outcomes scores, higher pain scores, and worse range of motion compared to primary RSA without prior RCR. [ABSTRACT FROM AUTHOR]

Background: This multicentre retrospective cohort study assessed whether functional outcomes after primary reverse shoulder arthroplasty (RSA) are favourable compared to secondary placement in elderly patients with displaced proximal humerus fractures (PHFs). Methods: Fifty-three patients with primary and 32 with secondary RSA were included. Patient-reported outcome measures (PROMs) were assessed: Constant–Murley Score (CMS), Oxford Shoulder Score (OSS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and Visual Analogue Scale (VAS). In addition, range of motion (ROM) was compared between groups. Result: For PROMs, the means (SD) for primary versus secondary were 25.4 (17.7), 29.4 (19.2) for DASH; 38 (8.6), 38 (9.1) for OSS; 63 (19.8), 59 (22.0) for CMS and 2 (2.0), 3 (2.3) for VAS. For ROM, the means were the following: forward flexion 113° (33.6), 106° (34.1); abduction 103° (33.4), 96° (37.3) and external rotation 20° (19.1), 20° (17.8). There were significant differences in favour of primary treatment in forward flexion (p = 0.003, B 19.85) and abduction (p = 0.034, B 17.34). Discussion: ROM in patients with complex displaced PHFs after primary RSA is slightly better than that after secondary treatment. Therefore, RSA could be considered primary treatment, especially when optimal ROM is of great importance to the patient. Level of evidence: level III, retrospective comparative study treatment study [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate the predictive determitants in patients with PHF who were treated with reverse shoulder arthroplasty (RSA) by evaluating the patient characteristics and comorbidities and extensive preoperative laboratory parameters. Methods: With examining the records of elderly patients (over 65 years old) with PHF, who were admitted to our emergency department between 2009 and 2020. For evaluation of the survival, we performed Kaplan-Meirer statistical anaylses. A Cox algorithms (uni and multivariate) were applied to recognize factors (including clinical and laboratory parameters) which are associated with survival. Results: Sixty-three females and 17 males were included with a mean of 73.5 ± 7.4 years of age. Nineteen (23.83%) patients had decreased after the surgery, with a mean survival of 47.5 ± 32.7 months. There were 61 (76.3%) surviving patients with a mean survival of 67.4 ± 35.4 months. Survival rates in the first 6 months (n: 2 patients), first year (n: 3 patients), and second year (n: 6 patients) after surgery were 97.5%, 96.3%, and 92.3%, respectively. Conclusion: The age and preoperative hemoglobin level were independently related with poor survival in patients with PHF. Level of Evidence: Level III Retrospective Cohort, Prognosis Study [ABSTRACT FROM AUTHOR]

Background: Insufficient tuberosity healing is the most common reason for poor outcome after treatment of proximal humerus fractures (PHFs) using hemiarthroplasty (HA). In these cases, revision to reverse total shoulder arthroplasty (RTSA) can improve function and reduce pain in the short term, however, long-term results remain scarce. Aim of this study was to evaluate the clinical and radiological mid- to long-term results in patients with a revision RTSA after failed HA for PHF. Methods: In this retrospective study all patients that received a revision to RTSA after failed fracture HA between 2006 and 2018 were included. A total of 49 shoulders in 48 patients (38 female, 10 male; mean age 82 ± 9 years) were identified in our database. A total of 20 patients (17 female, 3 male; mean age was 79 ± 9 years) were available for follow-up examination after a mean time period of approximately eight years (3–14 years) after revision surgery. At final follow-up, patients were assessed using a subjective shoulder value (SSV), range of motion (ROM), visual analogue score (VAS), the Constant Score (CS) and the 12-Item Short Form Survey (SF-12). Results: At final follow-up, mean CS was 55 ± 19 (19–91), VAS averaged 3 ± 3 (0–8) and mean SSV was 61 ± 18% (18–90%). Mean SF-12 was 44 (28–57) with a mean physical component summary (PCS) of 38 (21–56) and a mean mental component summary (MCS) of 51 (29–67). On average active forward flexion (FF) was 104° (10–170°), active abduction (ABD) was 101° (50–170°), active external rotation (ER) was 19° (10–30°) and active internal rotation (IR) of the lumbosacral transition was reached. Three patients presented with a periprosthetic humeral fracture after RTSA implantation and underwent a reoperation (15%) during follow-up period. Conclusions: Revision RTSA results in promising clinical results in patients after initial failed HA after PHF. A complication and reoperation rate of 15% is tolerable in consideration of satisfactory functional and psychological outcome. Trial registration: Retrospectively registered. [ABSTRACT FROM AUTHOR]

Introduction: In reverse shoulder arthroplasty (RSA) new designs enable greater amounts of lateralization to prevent instability and scapular notching and increase range of motion, however, excessive lateralization leads to stress upon the acromion that can result in scapular spine fatigue fractures. Aim of this study was to gender- and size-specifically assess the influence of glenosphere size and different humeral designs on lateralization, distalization, and bony impingement-free range of motion (ROM) in patients undergoing RSA. Methods: Computed tomography scans from 30 osteoarthritic patients (f:15, m:15) and 20 cuff tear arthropathy patients (f:10, m:10) were used to virtually simulate RSA implantation. The efficacy of an inlay Grammont-type system vs. an onlay lateralizing system combined with different glenosphere sizes (36 mm vs. 42 mm) in achieving ROM, lateralization, and distalization was evaluated. Moreover, gender and patient's constitution were correlated to humeral size by radiologically measuring the best-fit circle of the humeral head. Results: A different amount of relative lateralization was achieved in both genders using large glenospheres and onlay designs. Latter yielded a higher ROM in all planes for men and women with a 42 mm glenosphere; with the 36 mm glenosphere, an increased ROM was observed only in men. The 155° inlay design led to joint medialization only in men, whereas all designs led to lateralization in women. When adjusting the absolute amount of lateralization to humerus' size (or patient's height), regardless of implant type, women received greater relative lateralization using 36 mm glenosphere (inlay: 1%; onlay 12%) than men with 42 mm glenosphere (inlay: -3%; onlay: 8%). Conclusion: The relative lateralization achieved using onlay design is much higher in women than men. Small glenospheres yield greater relative lateralization in women compared to large glenospheres in men. Humeral lateralization using onlay designs should be used cautiously in women, as they lead to great relative lateralization increasing stress onto the acromion. Level of evidence: Basic Science Study, Computer Modeling. [ABSTRACT FROM AUTHOR]

With the rising prevalence of shoulder arthroplasty, the incidence of revision shoulder arthroplasty is also increasing. The complexity of these revision procedures poses significant challenges, with bone loss being a critical factor impacting treatment outcomes. Addressing substantial humeral bone defects is crucial for ensuring implant stability and functionality. A comprehensive literature review was conducted using PubMed, Medline, and Google Scholar to identify existing classification systems for proximal humeral bone loss in the context of revision shoulder arthroplasty. The study assessed the advantages and limitations of these classifications, using this information to propose a new diagnostic and therapeutic algorithm. Several classification systems for proximal humeral bone loss were identified. McLendon et al. classify proximal humeral bone loss based on a 5-cm bone loss threshold and suggest an allograft prosthesis composite for losses exceeding this limit. Boileau's system stratifies bone loss into four types based on the extent of loss, with specific recommendations for each category. The PHAROS classification provides a detailed anatomical assessment but lacks quantitative precision. The proposed PHBL-SCORe system offers a novel algorithm incorporating preoperative radiographic measurements to determine the percentage of bone loss and guide treatment options. Proximal humeral bone loss presents significant challenges in revision shoulder arthroplasty, necessitating precise preoperative planning and classification to guide surgical intervention. Existing classification systems provide valuable frameworks but often rely on average population values, neglecting individual anatomical variations. The proposed PHBL-SCORe system offers a patient-specific approach, improving the accuracy of bone loss assessment and optimizing treatment strategies. Implementing this classification in clinical practice could enhance surgical outcomes and reduce complications associated with rRSA (revision Reverse Shoulder arthroplasty). Further studies are required to validate this algorithm and explore its long-term efficacy in diverse patient populations. [ABSTRACT FROM AUTHOR]

Background: Scapular notching is a common complication of reverse total shoulder arthroplasty (RTSA). Although the notching rate has reduced significantly thanks to modifications to the surgical technique and humeral and glenoid components, uncontrollable polyethylene (PE)-induced osteolysis can still occur. In contrast to conventional-bearing (CB-RTSA), inverted-bearing RTSA (IB-RTSA) systems, with PE glenospheres and metal or ceramic humeral liners, avoid PE abrasion through scapulohumeral contact. If present, the resulting notch has a different size and configuration than with CB-RTSA. Thus, a modified notching classification seems reasonable. Even in CB-RTSA, the early stages of notching show a different configuration than implied by the established Nerot–Sirveaux classification; therefore, a modification of the classification system is recommended. Methods: In a prospective multicentre study, 250 cases underwent IB-RTSA. Of these, 39 died, and 28 were lost to follow-up for other reasons, leaving 183 shoulders for the final follow-up examination at a mean of 120.7 months (range 84.1–172.4 months). In the CB-RTSA group, we retrospectively evaluated radiographs of 59 consecutive patients with a follow-up ranging from 2 to 7 years. We analysed the appearance, evolution over time, and location of bone loss on the scapular neck according to the modified Nerot–Sirveaux classification. Results: In IB-RTSA, notching resulted in a new morphological configuration: In contrast to the Nerot–Sirveaux classification, notching began far from the baseplate as an impression or abrasion of the humeral component in the inferior scapular rim. Due to simultaneous mechanical ablation, the defect gradually enlarged, but usually did not contact the baseplate or extend beyond the inferior peg. No signs of PE-induced osteolysis were found. The notching rate reached 19% after 2 years and approached 36% after 10 years. Most shoulders had grade 0 notching (64%), followed by grade 1 (29%); extensive erosion (grade 4) was not observed. In the CB-RTSA group, a small bony impression or erosion without signs of PE-induced osteolysis was observed medial to the scapular neck, without contact with the metaglene in the early phase, which was similar to the impression of the humeral component in IB-RTSA. The notching rate was 86% for CB-RTSA. Conclusions: A new classification was developed for IB-RTSA, which corresponds to the pathophysiological processes and is compatible with the existing Nerot–Sirveaux classification. Bone erosion in CB-RTSA is not adequately represented by the established classification in the early stages. For this reason, a supplement to the existing classification is presented. Level of evidence: Level 4, Case Series, Treatment Study. [ABSTRACT FROM AUTHOR]

Background/aim: This study aimed to scrutinize nationwide utilization trends of shoulder arthroplasty for proximal humerus fractures (PHFs) using a comprehensive national surgical database. Materials and methods: A retrospective study was conducted with 4181 patients who underwent shoulder arthroplasty due to PHF between 2016 and 2022 using national health records. They are grouped as hemiarthroplasty (HA), anatomical total shoulder arthroplasty (TSA), and reverse shoulder arthroplasty (RSA). The patients' demographic data, length of hospital stay, revision histories, transfusion rates, mortality data, trends in arthroplasty methods over the years, the distribution of cases by hospital characteristics and geographical regions were analyzed. Results: Treatment with HA was administered to 22.1% of patients, TSA to 30.2%, and RSA to 47.7%. The lowest revision rate was observed after HA (4.3%), while higher rates were recorded after TSA (7.9%) and RSA (7.4%) (p = 0.019). It was observed that there was a significant increasing trend in RSA rates and a decreasing trend in HA and TSA rates over time (p < 0.001). Conclusion: From 2016 to 2022, there appears to have been a significant increase in the utilization of RSA for the arthroplasty treatment of proximal humeral fractures in Türkiye, and it is used more frequently than HA. However, revision rates after RSA are still higher than those after HA. [ABSTRACT FROM AUTHOR]

Background: Achondroplasia can result in many skeletal manifestations, and degenerative osteoarthritis can develop in patients with achondroplasia. Morphologic changes to both the humerus and glenoid--short humeri with patulous metaphyses and a medialized glenoid--can cause challenges that must be overcome to achieve a successful surgical result in a patient with shoulder dysfunction. Because patients with achondroplasia have near-normal life expectancies, the operative shoulder must be functional as well as quite durable in the long term. In an achondroplastic dwarf with shoulder osteoarthritis and rotator cuff insufficiency, achieving functionality and durability requires the use of a reverse total shoulder arthroplasty (TSA). This procedure has its own set of issues, namely, baseplate fixation and correction of glenoid medialization, if present. Case Report: We present the case of an adult with achondroplastic dwarfism with shoulder osteoarthritis and rotator cuff insufficiency and report the 2-year clinical results for this patient after reverse TSA. Conclusion: Reverse TSA is a viable treatment option for adult achondroplastic patients with shoulder dysfunction. Careful pre-operative planning is required to ensure a good clinical result in patients with potentially dysplastic anatomy. [ABSTRACT FROM AUTHOR]

Introduction: Acromial stress fracture (ASF) is an uncommon but acknowledged complication of reverse total shoulder arthroplasty (RTSA). There is no standardised method to directly measure the bone mineral density of the acromion to allow a detailed analysis of the potential mechanism of ASF. The aim is to establish a reliable and reproducible technique for measurement of acromial density on computer tomography (CT). Methods: A retrospective review on CT scans obtained for three groups of patients: those planned for RTSA (n = 26); age and gender‐matched non‐operative (n = 26); and young non‐operative patients (n = 28) were performed. Standardised axial images of 1 mm thickness at 1 mm increments were created following horizontal straightening on the coronal and sagittal views. To assess inter‐rater reliability, two senior CT radiographers performed density measurements using standard region of interest (ROI) tool on the CTs with the ROI placed on the mid (ROI 1) and posterior (ROI 2) acromion. ROIs were selected as the most common locations for acromion fracture post RTSA. Measurements were repeated at least 6 weeks apart. Intra‐class coefficients (ICC) were used to determine intra‐ and inter‐rater reliability. Results: ICCs demonstrated good to high intra‐rater and inter‐rater reliability for both ROI 1 and ROI 2 across all three groups. The lower margin of 95% confidence intervals was more than 0 for all intra‐class coefficients. Conclusion: This study demonstrates a reliable method of measuring acromion density on CT. This method can be used to assess bone mineral density in the clinical setting and in future studies investigating ASF following RTSA. [ABSTRACT FROM AUTHOR]

Background: Massive irreparable rotator cuff tears (MIRCTs) remain a challenging treatment paradigm, particularly for nonelderly patients without pseudoparalysis or arthritis. Purpose: To use a network meta-analysis to analyze comparative studies of surgical treatment options for MIRCTs in patients <70 years of age for several patient-reported outcomes, range of motion (ROM), and acromiohumeral distance (AHD). Study Design: Network meta-analysis of comparative studies; Level of evidence, 3. Methods: A systematic review of the literature, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of the MEDLINE, Embase, and Cochrane Library databases was conducted from 2017 to 2022. Inclusion criteria were (1) clinical comparative studies of MIRCTs (with several study-specific criteria); (2) ≥1 outcome of interest reported on, with standard deviations; (3) minimum 1-year follow-up; and (4) mean age of <70 years for both cohorts, without arthritis or pseudoparalysis. There were 8 treatment arms compared. Outcomes of interest were the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, visual analog scale for pain, AHD, and forward flexion and external rotation ROM. A frequentist approach to network meta-analysis with a random-effects model was performed using the netmeta package Version 0.9-6 in R. Results: A total of 23 studies met the inclusion criteria, with 1178 patients included in the network meta-analysis. There was a mean weighted age of 62.8 years, 568 (48.2%) men, with a mean follow-up of 28.9 months. There were no significant differences between groups in regard to sex (P =.732) or age (P =.469). For the ASES score, InSpace balloon arthroplasty (mean difference [MD], 12.34; 95% CI, 2.18 to 22.50; P =.017), arthroscopic bridging graft (aBG) (MD, 7.07; 95% CI, 0.28 to 13.85; P =.041), and long head of biceps augmented superior capsular reconstruction (BSCR) (MD, 5.16; 95% CI, 1.10 to 9.22; P =.013) resulted in the highest P-scores. For the Constant-Murley score, debridement (MD, 21.03; 95% CI, 8.98 to 33.08; P <.001) and aBG (MD, 6.97; 95% CI, 1.88 to 12.05; P =.007) resulted in the highest P-scores. For AHD, BSCR resulted in the highest P-score (MD, 1.46; 95% CI, 0.45 to 2.48; P =.005). For forward flexion ROM, debridement (MD, 45.77; 95% CI, 25.41 to 66.13; P <.001) resulted in the highest P-score, while RSA resulted in the lowest P-score (MD, –16.70; 95% CI, −31.20 to −2.20; P =.024). Conclusion: For patients <70 years with MIRCT without significant arthritis or pseudoparalysis, it appears that graft interposition repair techniques, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains, while RSA provides the least benefit in forward flexion. [ABSTRACT FROM AUTHOR]

The preferred surgical approach for surgical treatment of advanced glenohumeral arthritis is shoulder arthroplasty (SA). Considering the growing volume and success of SA, patients with bilateral shoulder disease are likely to undergo surgery on both shoulders. There are numerous studies evaluating the outcomes of bilateral hip and knee arthroplasty, but a paucity of information examining bilateral SA. This study intends to evaluate the clinical outcomes of patients undergoing staged bilateral anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA). Institutional records were queried for patients who underwent staged bilateral aTSA or rTSA from 2009 to 2020. Patient records were retrospectively reviewed to assess preoperative and postoperative range of motion (ROM) and strength measurements, demographic information, and complications. Mean ± standard deviation was reported for all continuous variables. Mean functional measurements were compared using a 2-Sample t -Test, ordinal variables via Wilcoxon-Mann Whitney test, and categorical variables via Chi-squared test. Patients were included in the outcome analysis if they had a bilateral TSA with the same procedure (i.e. aTSA on both sides, or rTSA on both sides). 43 patients (15 male, 28 female) were included. There was an average time of 1.8 years between surgeries. Of the 43 patients, 26 patients had staged bilateral aTSAs and 14 had staged bilateral rTSAs with three patients who had different surgeries on each shoulder. The three patients with different surgeries on each shoulder were excluded from outcome analysis. Patients who had staged aTSA operations demonstrated significant improvement in external rotation (P =.0191, P <.001), forward elevation (FE) (P =.0004, P <.001), and internal rotation (IR) (P =.0183, P =.0166) after the first and second surgeries. Staged rTSA patients showed significant improvement in FE after the first (P =.0043) and second surgeries (P =.016). Patients demonstrated significant increase in strength of external rotation (P =.0136), FE (P =.0088), and IR (P =.0206) after the first rTSA. There was no corresponding increase in strength testing after the second bilateral rTSA surgery. The average Single Assessment Numeric Evaluation, Contralateral Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores for all surgeries were 84 ± 10, 83 ± 13, 75 ± 20, and 9 ± 2, respectively for the first surgery and 82 ± 13, 83 ± 13, 71 ± 21, and 8 ± 3 for the second surgery. Individuals that undergo staged aTSA procedures gain a better ROM and IR strength after both operations. However, individuals that undergo staged rTSA procedures have an improved ROM and strength after the first surgery but limited improvement after the second. [ABSTRACT FROM AUTHOR]

Radiographic evaluation of the implant configuration after reverse shoulder arthroplasty (RSA) is time-consuming and subject to interobserver disagreement. The final configuration is a combination of implant features and surgical execution. Artificial intelligence (AI) algorithms have been shown to perform accurate and efficient analysis of images. The purpose of this study was to develop an AI algorithm to automatically measure glenosphere inclination, humeral component inclination, and the lateralization and distalization shoulder angles (DSAs) on postoperative anteroposterior radiographs after RSA. The Digital Imaging and Communications in Medicine files corresponding to postoperative anteroposterior radiographs obtained after implantation of 143 RSAs were retrieved and used in this study. Four angles were analyzed: (1) glenoid inclination angle (GIA, between the central fixation feature of the glenoid and the floor of the supraspinatus fossa), (2) humeral alignment angle (HAA, between the long axis of the humeral shaft and a perpendicular to the metallic bearing of the prosthesis), (3) DSA, and (4) lateralization shoulder angle (LSA). A UNet segmentation model was trained to segment bony and implant elements using manually segmented training (n = 89) and validation (n = 22) images. Then, an image-processing–based pipeline was developed to measure all 4 angles using AI-segmented images. Measures performed by 3 physician observers and the AI algorithm were then completed in 32 additional images. The agreements among human observers and between observers and the AI algorithm were evaluated using intraclass correlation coefficients (ICCs) and absolute differences in degree. The ICCs (95% confidence interval) for manual measurements of LSA, DSA, GIA, and HAA were 0.79 (0.55, 0.90), 0.90 (0.80, 0.95), 0.96 (0.93, 0.98), and 0.99 (0.97, 0.99), respectively. The AI algorithm measured the 32 images in the test set in less than 2 minutes. The agreement between observers and the AI algorithm was lowest when measuring the LSA for observer 2, with an ICC of 0.77 (0.52, 0.89), and an absolute difference in degrees (median [interquartile range]) of 5 (4). Better agreements were found between the AI measurements and the average manual measurements: absolute differences in degree for LSA, DSA, GIA, and HAA were 3 (5), 2 (3), 2 (2), and 2 (1), respectively; ICCs for LSA, DSA, GIA, and HAA were 0.89 (0.79, 0.95), 0.96 (0.93, 0.98), 0.85 (0.68, 0.93), and 0.98 (0.95, 0.99), respectively. The AI algorithm developed in this study can automatically measure the GIA, HAA, LSA, and DSA on postoperative anteroposterior radiographs obtained after implantation on RSA. [ABSTRACT FROM AUTHOR]