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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]

The purpose of this review was to evaluate the effect of Photobiomodulation (PBM) in managing shoulder and neck pain and disability. A literature search was conducted using the PubMed and ScienceDirect/EMBASE databases. The keywords used were "Low-level laser therapy", "photobiomodulation", "LASER", combined with "shoulder" or "neck". Only clinical studies written in English, Portuguese, Spanish, Italian, French, and German, were included. The review included 36 studies applying PBM therapy to alleviate pain or disability in patients with shoulder and neck conditions. Of these, 12 studies focused on neck conditions, and 24 studies addressed shoulder conditions, with one study concurrently examining both areas. This review on PBM therapy for shoulder and neck conditions shows promising results, particularly in pain relief and functional improvements, with infrared wavelengths being the most commonly used. Subacromial Impingement Syndrome (SAIS) and Myofascial Pain Syndrome (MPS) were the most frequently studied conditions. However, chronic and complex conditions like cervical osteoarthritis and post-stroke shoulder pain were less frequently represented, indicating a research gap. PBM was found to be a safe and non-invasive therapeutic option. Despite positive outcomes, variability in PBM protocols remains a challenge. Further standardized trials are needed to confirm its effectiveness across diverse conditions. This review updates current knowledge, highlights key findings, and provides direction for future research and clinical applications. [ABSTRACT FROM AUTHOR]

Glenohumeral osteoarthritis (GOA) is characterized by chronic inflammation leading to joint damage. Extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs) are promising therapies because of their immunomodulatory functions. The anti-inflammatory effects of EVs from human Adipose-derived MSCs (hADSCs) overexpressing microRNA (miR)-146a were investigated in experimental GOA in this study. hADSCs were transfected with a mimic negative control or miR-146a mimics. GOA was induced in C57/Bl6j mice, and subsequently, the animals were treated intra-articularly with phosphate-buffered saline, miR-146a EVs, or miR-control EVs. The expression of miR-146a and its targeted cytokines interleukin (IL)-4, IL-10, tumor necrosis factor-alpha (TNF-α), IL-17, and interferon-gamma (IFN-γ) were analyzed in the spleen of mice by enzyme-linked immunosorbent assay and in the articular cartilage by real-time polymerase chain reaction. miR-146a EVs showed enrichment of miR-146a. In GOA mice, miR-146a EV treatment significantly reduced expression levels of inflammatory cytokines IFN-γ, IL-17, and TNF-α and increased the anti-inflammatory cytokine IL-10 and IL-4 compared to controls. miR-146a EV treatment raised the anti-inflammatory cytokines and reduced the pro-inflammatory cytokines of the spleen in treated mice. This study demonstrates that EVs derived from hADSCs overexpressing miR-146a have enhanced anti-inflammatory potential in GOA by modulating cytokine expression and production. EVs engineered with inflammation-related miRNAs could be a cell-free therapeutic approach for GOA. [ABSTRACT FROM AUTHOR]

Background: Glenoid loosening is an issue in anatomic total shoulder arthroplasty (a-TSA). This has been attributed to abnormal glenoid anatomy, common among these patients. Different alternatives have been proposed to tackle glenoid bone loss and restore joint alignment with augmented glenoid implants being increasingly used to deal with this problem. This systematic review aims to evaluate the clinical and radiological outcomes of patients undergoing augmented glenoid a-TSAs. Our hypothesis was that augmented glenoid components will lead to good patient outcomes with a low incidence of complications and revision procedures. Methods: MEDLINE, EMBASE, CENTRAL and CINHAL were searched from inception to February 2022 for information pertaining to outcomes of patients undergoing a-TSA with augmented glenoid implants. Results: Eighteen studies reported on outcomes of 814 a-TSA (800 participants) with a mean follow-up of 3.7 years. Most studies (67%) were Type IV level of evidence. Almost 70% of participants underwent an a-TSA secondary to primary glenohumeral osteoarthritis. Most glenoids were type B2 (73%). Augmented glenoids material was mostly all-polyethylene (81%) with full wedge (45%) and stepped components (38%) designs being the most common. Most studies reported good clinical outcomes. 17 patients (4%) underwent a revision surgery. Conclusions: Our review found that patients undergoing a-TSA with augmented glenoid components report good outcomes at short-to-mid-term follow-up. Further research is warranted to determine if such outcomes remain similar in long term. Level of evidence: Level III, Systematic Review of Therapeutic Studies. [ABSTRACT FROM AUTHOR]

The decision to treat shoulder osteoarthritis (OA) definitively with shoulder arthroplasty (SA) is multifactorial, considering objective findings, subjective information, and patient goals. The first goal of this study was to determine if Patient Reported Outcome Measurement Information System (PROMIS) measures correlated with patients with shoulder OA who underwent SA within 1 year. The second goal of this study was to determine if score cut-offs in PROMIS domains could further discriminate which shoulder OA patients underwent SA within 1 year. This retrospective case-control study examined patients with a diagnosis of shoulder OA who consulted an orthopedic provider from November 1, 2020 to May 23, 2022, and recorded PROMIS measures in the domains of Physical Function, Depression, and/or Pain Interference. A surgical group was defined as patients who underwent SA within 1 year of the most recent PROMIS measures and the nonsurgical patients were defined as the control group. Mean PROMIS scores were compared between the surgical and control groups. Separate logistic regression models controlling for age, race, ethnicity, and comorbidity count were performed for each PROMIS domain as a 1) continuous variable, and then as 2) binary variable defined by PROMIS score cut-off points to determine which scores correlated with undergoing SA to further characterize the potential clinical utility of PROMIS score cut-offs in relating to undergoing SA. The surgical group of 478 patients was older (68.2 vs. 63.8 years), more often of White race (82.6% vs. 70.9%), and less often of Hispanic Ethnicity (1.5% vs. 2.9%) than the control group of 3343 patients. Using optimal cut-offs in PROMIS scores, Pain Interference ≥63 (odds ratio [OR] = 2.97 (2.41-3.64), P <.001), Physical Function ≤39 (OR = 1.81 (95% confidence interval, 1.48-2.22), P <.001), and depression ≥49 (OR = 1.82 (95% confidence interval, 1.50-2.22), P <.001) were all found to correlate with undergoing SA within 1 year in multivariable logistic regressions. The results of this study demonstrate that cut-off scores for PROMIS measures differentiated patients undergoing SA within 1 year. These cut-off scores may have clinical utility in aiding in decision-making regarding surgical candidates for SA. Further research is needed to validate these cut-off scores and determine how they relate to patient outcomes after SA. [ABSTRACT FROM AUTHOR]

Background: Total shoulder arthroplasty (TSA) in patients with rheumatoid arthritis (RA) can present unique challenges. The aim of this study was to compare both systemic and joint-related postoperative complications in patients undergoing primary TSA with RA versus those with primary osteoarthritis (OA). Methods: Using the TriNetX database, Current Procedural Terminology and International Classification of Diseases, 10th edition codes were used to identify patients who underwent primary TSA. Patients were categorized into two cohorts: RA and OA. After 1:1 propensity score matching, postoperative systemic complications within 90 days following primary TSA and joint-related complications within 5 years following anatomic TSA (aTSA) and reverse shoulder arthroplasty (RSA) were compared. Results: After propensity score matching, the RA and OA cohorts each consisted of 8,523 patients. Within 90 days postoperation, RA patients had a significantly higher risk of total complications, deep surgical site infection, wound dehiscence, pneumonia, myocardial infarction, acute renal failure, urinary tract infection, mortality, and readmission compared to the OA cohort. RA patients had a significantly greater risk of periprosthetic joint infection and prosthetic dislocation within 5 years following aTSA and RSA, and a greater risk of scapular fractures following RSA. Among RA patients, RSA had a significantly higher risk of prosthetic dislocation, scapular fractures, and revision compared to aTSA. Conclusions: Following TSA, RA patients should be considered at higher risk of systemic and joint-related complications compared to patients with primary OA. Knowledge of the risk profile of RA patients undergoing TSA is essential for appropriate patient counseling and education. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Background: This study sought to determine if preoperative forward elevation (FE) weakness affects outcomes of anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) for patients with rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA). Methods: A retrospective review of a single institution's prospectively collected shoulder arthroplasty database was performed between 2007 and 2020, including 333 aTSAs and 155 rTSAs for primary RCI-GHOA with a minimum 2-year follow-up. Defining preoperative weakness as FE strength ≤4.9 lb (2.2 kg), three cohorts were matched 1:1:1 by age, sex, and follow-up: weak (n=82) to normal aTSAs, weak (n=44) to normal rTSAs, and weak aTSAs (n=61) to weak rTSAs. Compared outcomes included range of motion, outcome scores, and complication and revision rates at latest follow-up. Results: Weak aTSAs and weak rTSAs achieved similar postoperative outcome measures to normal aTSAs and normal rTSAs, respectively (P>0.05). Compared to weak rTSAs, weak aTSAs achieved superior postoperative passive (P=0.006) and active external rotation (ER) (P=0.014) but less favorable postoperative Shoulder Pain and Disability Index (P=0.032), American Shoulder and Elbow Surgeons (P=0.024), and University of California, Los Angeles scores (P=0.008). Weak aTSAs achieved the minimal clinically important difference (MCID) and substantial clinical benefit at a lower rate for abduction (P=0.045 and P=0.003) and FE (P=0.011 and P=0.001). Weak aTSAs had a higher revision rate (P=0.025) but a similar complication rate (P=0.291) compared to weak rTSAs. Conclusions: Patients with RCI-GHOA and preoperative FE weakness obtain postoperative outcomes similar to patients with normal preoperative strength after either aTSA or rTSA. Preoperatively, weak aTSAs achieved greater ER but lower rates of clinically relevant improvement in overhead motion compared to weak rTSAs. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Biconcave (B2) glenoids, characterized by significant posterior glenoid bone loss and a biconcave wear pattern, are a challenging pathology in shoulder surgery. Significant bone defects present in B2 glenoids increases the risk of complications and rates of failure for operative patients with glenohumeral osteoarthritis. Diagnosing this entity is of pivotal importance, and can be accomplished with imaging and a comprehensive clinical investigation. There are no clear-cut guidelines for management, but options include hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse shoulder arthroplasty. In recent years, modern techniques such as corrective reaming, bone grafts, and the use of augmented components have improved patient outcomes. Educating prospective patients is essential for reaching a shared management decision, setting appropriate expectations, and optimizing prognostic outcomes. [ABSTRACT FROM AUTHOR]

Background: Shoulder osteoarthritis can cause significant pain and disability. It is thought that the wider principles of osteoarthritis management can be applied in the management of people with shoulder osteoarthritis, but most prior research has been conducted with people experiencing osteoarthritis of the hip and knee. There is a paucity of evidence to guide the non‐surgical management of shoulder osteoarthritis and limited understanding of current physiotherapy practice. Objective: We aimed to investigate the current treatment recommendations by physiotherapists in the UK for people with shoulder OA. Methods: An online survey using a clinical vignette was designed and distributed to UK registered physiotherapists with experience of managing people with shoulder osteoarthritis, via social media and professional networks. Descriptive statistics were used to analyse demographic and multiple‐choice questions, and free text responses were summarised narratively. Results: 114 respondents accessed the survey with 110 valid responses; 105 (95%) respondents would offer face‐to‐face consultations, with 89 (81%) respondents expecting to offer 2–4 appointments. 108 (98%) respondents would offer advice/education; 79 (72%) would offer weight management; 82 (75%) prescribed exercises to improve movement; and 101 (92%) offered exercises to increase strength. If a person lived with obesity or had a treatment preference, the majority of respondents would change their recommendations. Conclusion: This is the first survey of NHS physiotherapy practice for people with shoulder osteoarthritis. The responses largely align with NICE guidelines; despite this alignment, it is not known whether such guideline‐based care is acceptable to people with shoulder osteoarthritis or clinically effective. [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]

Total shoulder arthroplasty (TSA) is an effective treatment option for glenohumeral arthritis. It is unclear if seasonal timing of surgery affects outcomes. Patients who underwent TSA between 2015 and 2021 and were enrolled in a multicenter registry were eligible for inclusion. Date of surgery was recorded and was divided up into winter, spring, summer, and fall. Demographic data and Walch classification were recorded. Baseline strength, range of motion (ROM), and patient-reported outcomes were recorded. Patient-reported outcomes and ROM at 2 years of follow-up were assessed and compared between TSA groups for each season. Overall, 506 patients were included in the analysis. Breakdown by season was winter (N = 124), spring (N = 118), summer (N = 120), and fall (N = 144). There were no differences in baseline demographics between patients based on season of surgery or Walch classification. No difference existed in baseline ROM, clinical outcomes, or strength between seasonal groups. There were no differences in 2-year clinical outcomes, ROM, or strength between groups. There is no difference in clinical outcomes based on seasonal timing for patients who undergo TSA. Patients should feel confident that their outcomes will not vary based on the season in which they undergo TSA. [ABSTRACT FROM AUTHOR]

Sleep apnea (SA) has been shown to negatively affect cognition, immunity, and bone mineralization. There is conflicting evidence for the contribution of SA to outcomes following total shoulder arthroplasty. However, the impact of SA on reverse shoulder arthroplasty (RSA) has not been elucidated. A substantial increase in utilization of RSA is projected through the 2030s. Our objective was to assess postoperative medical and implant-related complications and healthcare utilization in patients with SA undergoing RSA. A retrospective review of a private insurance claims database was conducted from 2010 to 2021. All cases of RSA and those with a prior diagnosis of SA were identified using their corresponding diagnosis and procedural codes. Patients undergoing RSA with a diagnosis of SA were matched to control patients 1:2 based on demographic and comorbidity profiles. A total of 18,229 SA patients were matched to 35,988 control patients. The SA cohort had significantly greater odds of all medical complications assessed compared to the control cohort. The SA cohort had greater odds of all implant-related complications including dislocation and mechanical loosening when compared to the control cohort. Mean length of stay was significantly greater in the SA group. The current data demonstrate that SA patients may have an increased risk of complications and healthcare burden following RSA compared to RSA patients without SA. These findings indicate potential value in preoperative screening for SA prior to RSA. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the present study was to evaluate clinical and functional outcomes, graft integrity rate and progression of osteoarthritis after superior capsular reconstruction (SCR) at short-term follow-up. Methods: Consecutive patients that underwent SCR using an acellular dermal xeno- or allograft between May 2018 and June 2020 for the treatment of irreparable posterosuperior rotator cuff tears were included. Shoulder function (American Shoulder and Elbow Surgeons [ASES] score), pain (Visual Analog Scale [VAS] for pain) and active shoulder range of motion (ROM) were evaluated preoperatively and after a minimum of 24 months postoperatively. Isometric strength was measured at follow-up and compared to the contralateral side. Magnetic resonance imaging was performed to evaluate graft integrity and osteoarthritis progression (shoulder osteoarthritis severity [SOAS] score). Results: Twenty-two patients that underwent SCR using a xeno- (n = 9) or allograft (n = 13) were evaluated 33.1 ± 7.2 months postoperatively. Four patients in the xenograft group underwent revision surgery due to pain and range of motion limitations and were excluded from further analysis (revision rate: 18.2%). Shoulder function (ASES score: 41.6 ± 18.8 to 72.9 ± 18.6, p < 0.001), pain levels (VAS for pain: 5.8 ± 2.5 to 1.8 ± 2.0, p < 0.001) and active flexion (p < 0.001) as well as abduction ROM (p < 0.001) improved significantly from pre- to postoperatively. Active external rotation ROM did not improve significantly (p = 0.924). Isometric flexion (p < 0.001), abduction (p < 0.001) and external rotation strength (p = 0.015) were significantly lower in the operated shoulder compared to the non-operated shoulder. Ten shoulders demonstrated a graft tear at the glenoid (n = 8, 44.4%) or humerus (n = 2, 11.1%). Graft lysis was observed in seven shoulders (38.9%). The graft was intact in one shoulder (5.6%), which was an allograft. A significant progression of shoulder osteoarthritis was observed at follow-up (SOAS score: 42.4 ± 10.1 to 54.6 ± 8.4, p < 0.001). Conclusions: At short-term follow-up, SCR using an acellular dermal xeno- or allograft resulted in improved shoulder function and pain with limitations in active external rotation ROM and isometric strength. Graft failure rates were high and osteoarthritis progressed significantly. Level of Evidence: Retrospective cohort study, Level III. [ABSTRACT FROM AUTHOR]

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

This document is a correction notice for an article titled "The fifty most cited publications in shoulder arthroplasty research." It provides the missing information for number 14 in the list of the top 50 cited shoulder arthroplasty articles. The article itself presents a comprehensive list of the top 50 cited publications in shoulder arthroplasty research, covering topics such as osteoarthritis treatment, proximal humeral fractures, and rotator cuff tears. The articles encompass various aspects of shoulder arthroplasty, including surgical techniques, outcomes, complications, and implant designs. This list serves as a valuable resource for researchers and library patrons interested in exploring and studying shoulder arthroplasty. [Extracted from the article]

Glenohumeral degenerative joint disease may affect up to 20% of the population. There are several classification systems of this disease in the scientific literature. The aim of this study is to determine the reliability and reproducibility of glenohumeral osteoarthritis classification systems. We assessed glenohumeral plain radiographs performed in a University Hospital. These radiographs were graded into nine radiological classification systems by two observers on two evaluations. Patients who have performed CT/MRI scan were staged according to the Walch classification. The intra-observer and inter-observer reliability of the classification schemes were determined by using Cohen’s weighted kappa coefficient. A total of 752 patients were included in the study (52.4% females and 47.6% males), mean aged 66.2 ± 16.3 years. The intra-observer and inter-observer reliabilities were 0.543 (observer 1), 0.630 (observer 2), and 0.760 (inter-observer) for the Weinstein grading system; 0.661, 0.706, and 0.761 for the Guyette grading system; 0.575, 0.679 and 0.704 for the Kellgren and Lawrence classification; 0.817, 0.816 e 0.871 for the Samilson and Prieto classification; 0.791, 0.811 and 0.847 for the Allain modification; 0.797, 0.842 and 0.860 for the Gerber modification; 0.773, 0.827 and 0.828 for the Buscayret modification; 0.584, 0.648 and 0.755 for the Hawkins and Angelo classification; 0.661, 0.749 and 0.764 for the Rosenberg classification. Intra-observer reliability for MRI was 0.757 (observer 1) and 0.675 (observer 2), while intra-observer reliability for CT was 0.811 (observer 1) and 0.653 (observer 2). Inter-observer reliabilities were 0.790 for MRI and 0.673 for CT. The classification systems according to Weinstein, Guyette, Hawkins and Angelo, Rosenberg and the modifications of the Samilson and Prieto classification according to Allain, Gerber and Buscayret showed a comparable reliability with the commonly used glenohumeral osteoarthritis grading systems, Samilson and Prieto and Kellgren and Lawrence. Thus, they are recommended for clinical and especially scientific purposes. [ABSTRACT FROM AUTHOR]

Anthropometric studies of the scapula have been rare in Spanish populations, nevertheless they are of current interest in forensic anthropology for estimation of sex. Although the estimation of sex is usually carried out on the pelvis and skull, other measurements related to the scapula can be helpful when the skeletal remains are incomplete. Glenohumeral osteoarthritis development is influenced, among others, by the morphology of the scapula, which is one of the less studied aspects. We carried out a descriptive study of anthropometric parameters in a series of 157 scapulae (82 individuals) on bone remains dated to the 20th century from a population of Granada (Southern Spain). Seventy seven (49%) were right-side and 80 (51%) left-side; 72 (45.9%) were from males and 85 (54.1%) from females, and the mean age at death was 70.76±11.7 years. The objective was to develop a discrimination function for sex estimation based on anthropometric parameters of the scapula other than those considered to date, and to analyze the prevalence of glenohumeral osteoarthritis in relation to selected anthropometric parameters. A logistic regression model based on parameters of the upper-external segment of the scapula was done. The obtained formula: 1/1+e^ (- (-57.911 + 0.350*B + 0283*C + 0.249*b + 0.166*a +-0.100*β) classifies male sex with 98.3% accuracy and female sex with 92.1%. Glenohumeral osteoarthritis was detected in 16.6% of individuals and was related to age (p<0.05), scapular length (p<0.05), glenoid width (p<0.05), glenopolar angle (p<0.05), and α angle (p<0.05) in bivariate analyses but showed no significant associations in multivariate analyses. This approach can be useful for anthropological-forensic identification when scapula remains are incomplete. Glenohumeral osteoarthritis is significantly associated with a smaller α angle. [ABSTRACT FROM AUTHOR]

Background: Metallic lateralized-offset glenoid reverse shoulder arthroplasty (RSA) for cuff tear arthropathy combines the use of a metallic augmented baseplate with a metaphyseally oriented short stem design that can be applied at a 135° or 145° neck-shaft angle, leading to additional lateralization on the humeral side. Lateralization of the center of rotation decreases the risk of inferior scapular notching and improves external rotation, deltoid wrapping, residual rotator cuff tensioning, and prosthetic stability1-4. Metallic increased-offset RSA (MIO-RSA) achieves lateralization and corrects inclination and retroversion while avoiding graft resorption and other complications of bony increased-offset RSA (BIO-RSA)5-8. Reducing the neck-shaft angle from the classical Grammont design, in combination with glenoid lateralization, improves range of motion9,10 by reducing inferior impingement during adduction at the expense of earlier superior impingement during abduction2,11. Lädermann et al.12 investigated how different combinations of humeral stem and glenosphere designs influence range of motion and muscle elongation. They assessed 30 combinations of humeral components, as compared with the native shoulder, and found that the combination that allows for restoration of >50% of the native range of motion in all directions was a 145° onlay stem with a concentric or lateralized tray in conjunction with a lateralized or inferior eccentric glenosphere. In addition, the use of a flush-lay or a slight-onlay stem design (like the one utilized in the presently described technique) may decrease the risk of secondary scapular spine fracture13,14. The goal of this prosthetic design is to achieve an excellent combination of motion and stability while reducing complications. Description: This procedure is performed via a deltopectoral approach with the patient in the beach-chair position under general anesthesia combined with a regional interscalene nerve block. Subscapularis tenotomy and capsular release are performed, the humeral head is dislocated, and any osteophytes are removed. An intramedullary cutting guide is placed for correct humeral resection. The osteotomy of the humeral head is performed in the anatomical neck with an inclination of 135° and a retroversion of 20° to 40°, depending on the anatomical retroversion. The glenoid is prepared as usual. The lateralized, augmented baseplate is assembled with the central screw and the baseplate-wedge-screw complex is placed by inserting the screw into the central screw hole. Four peripheral screws are utilized for definitive fixation. An eccentric glenosphere with inferior overhang is implanted. The humerus is dislocated, and the metaphysis is prepared. Long compactors are utilized for proper stem alignment, and an asymmetric trial insert is positioned before the humerus is reduced. Stability and range of motion are assessed. The definitive short stem is inserted and the asymmetric polyethylene is impacted, resulting in a neck-shaft angle of 145°. Following reduction, subscapularis repair and wound closure are performed. Alternatives: BIO-RSA is the main alternative to MIO-RSA. Boileau et al.15 demonstrated satisfactory early and long-term outcomes of BIO-RSA for shoulder osteoarthritis. A larger lateral offset may also be achieved with a thicker glenosphere2,16. Mark A. Frankle developed an implant that addressed the drawbacks of the Grammont design: a lateralized glenosphere combined with a 135° humeral neck-shaft angle. The 135° neck-shaft angle provides lateral humeral offset, preserving the normal length-tension relationship of the residual rotator cuff musculature, which optimizes its strength and function. The lateralized glenosphere displaces the humeral shaft laterally, minimizing the potential for impingement during adduction2,9,17,18. The advantage of BIO-RSA and MIO-RSA over lateralized glenospheres is that the former options provide correction of angular deformities without excessive reaming, which can lead to impingement19. Rationale: BIO-RSA has been proven to achieve excellent functional outcomes15,20,21; however, the bone graft can undergo resorption, which may result in early baseplate loosening. Bipolar metallic lateralized RSA is an effective strategy for achieving lateralization and correction of multiplanar defects while avoiding the potential complications of BIO-RSA6,7,22-24. MIO-RSA also overcomes another limitation of BIO-RSA, namely that BIO-RSA is not applicable when the humeral head is not available for use (e.g., humeral head osteonecrosis, revision surgery, fracture sequelae). Expected Outcomes: A recent study evaluated the clinical and radiographic outcomes of metallic humeral and glenoid lateralized implants. A total of 42 patients underwent primary RSA. Patients were documented prospectively and underwent follow-up visits at 1 and 2 years postoperatively. That study demonstrated that bipolar metallic lateralized RSA achieves excellent clinical results in terms of shoulder function, pain relief, muscle strength, and patient-reported subjective assessment, without instability or radiographic signs of scapular notching23. Kirsch et al.25 reported the results of primary RSA with an augmented baseplate in 44 patients with a minimum of 1 year of clinical and radiographic follow-up. The use of an augmented baseplate resulted in excellent short-term clinical outcomes and substantial deformity correction in patients with advanced glenoid deformity. No short-term complications and no failure or loosening of the augmented baseplate were observed. Merolla et al.7 compared the results of 44 patients who underwent BIO-RSA and 39 patients who underwent MIO-RSA, with a minimum follow-up of 2 years. Both techniques provided good clinical outcomes; however, BIO-RSA yielded union between the cancellous bone graft and the surface of the native glenoid in <70% of patients. On the other hand, complete baseplate seating was observed in 90% of MIO-RSA patients. Important Tips: When performing subscapularis tenotomy, leave an adequate stump to allow end-to-end repair. Tenotomize the superior part of the subscapularis tendon in an L-shape, sparing the portion below the circumflex vessels. As glenoid exposure is critical, perform a 270° capsulotomy. Continuously check the orientation of the baseplate relative to the prepared hole and reamed surface to ensure accurate implantation of the full wedge baseplate to achieve a proper fit. Aim for 70% to 80% seating of the baseplate onto the prepared glenoid surface. Avoid overtightening or excessive advancement of the baseplate into the subchondral bone. Gaps between the baseplate and glenoid surface should also be avoided. In order to avoid varus or valgus malpositioning of the final implant, obtain proper diaphyseal alignment by following "the three big Ls": large, lateral, and long. Use a large metaphyseal component to fill the metaphysis. Place the guide pin for the reaming of the metaphysis slightly laterally into the resected surface of the humerus. Use long compactors for diaphyseal alignment to avoid varus or valgus malpositioning of the final implant. Use an intramedullary cutting guide for correct humeral resection. Utilize the correct liner in order to obtain proper tensioning and avoid instability. Acronyms and Abbreviations: K wire = Kirschner wire ROM = range of motion [ABSTRACT FROM AUTHOR]

The article focuses on evaluating the short-term results of reverse total shoulder arthroplasty (RTSA) for various shoulder disorders. Topics include the effectiveness of RTSA for massive rotator cuff tears, primary glenohumeral osteoarthritis, and nonunited proximal humerus fractures, as well as improvements in clinical and functional outcomes following the procedure.

Background: The impact of early glenohumeral osteoarthritis (GHOA) on clinical outcomes after rotator cuff repair (RCR) remains unclear. The magnetic resonance imaging (MRI)–based Shoulder Osteoarthritis Severity (SOAS) score is a comprehensive approach to quantifying glenohumeral degeneration. Purpose: To investigate the association between SOAS scores and changes in American Shoulder and Elbow Surgeons (ASES) scores in patients who underwent RCR. Study Design: Cohort study; Level of evidence, 3. Methods: Two reviewers independently analyzed the preoperative MRI scans of 116 shoulders and assigned SOAS scores. Spearman correlation was used to calculate the association of mean SOAS scores with patient demographic characteristics and change in ASES scores over the 2-year follow-up period (ΔASES). Multivariate regression analysis was performed between the independent variables of patient age, sex, body mass index, and significant SOAS score components as determined by univariate analysis, with the dependent variable being ΔASES. Significance was defined as P <.05 for univariate analysis and P <.0125 after application of the Bonferroni correction for multivariate analysis. Results: The mean ASES scores were 55.8 ± 18.6 preoperatively and 92.1 ± 12.1 at 2 years postoperatively. The mean preoperative SOAS score was 15.2 ± 7.1. On univariate analysis, the total SOAS score was positively correlated with patient age (r S = 0.41; P <.001), whereas ΔASES was negatively correlated with patient age (r S = −0.27; P =.0032). Increasing SOAS subscores for supraspinatus/infraspinatus tear size (r S = −0.28; P =.024), tendon retraction (r S = −0.23; P =.015), muscle atrophy (r S = −0.20; P =.034), paralabral ganglia (r S = −0.23; P =.015), and cartilage degeneration (r S = −0.21; P =.024) were negatively correlated with ΔASES. A negative correlation was found between increasing total SOAS score and ΔASES (r S = −0.22; P =.016). On multivariate analysis, increasing supraspinatus/infraspinatus tear size was significantly and negatively correlated with ΔASES (β = −3.3; P =.010). Conclusion: Increasing the total SOAS score was predictive of less improvement in ASES scores at 2 years postoperatively. On univariate analysis, SOAS subscores with the strongest negative correlations with ΔASES scores included tear size, muscle atrophy, tendon retraction, paralabral ganglia, and cartilage wear. On multivariate analysis, only tear size was significantly associated with a lower change in the ASES score. [ABSTRACT FROM AUTHOR]

Background: Anatomical total shoulder arthroplasty (TSA) and shoulder hemiarthroplasty (HA) have both been shown to have good outcomes in patients with osteoarthritis of the glenohumeral joint. However, evidence comparing perioperative complications between these procedures in this population is heterogeneous. Materials and Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried between the years 2012 and 2021 (10 years in total) for records of patients who underwent either TSA or HA for osteoarthritis of the glenohumeral joint. Patients in each group underwent a 1:1 propensity match for demographic variables. Bivariate and multivariate analyses were performed to compare complications and risk factors between these cohorts. Results: A total of 4376 propensity-matched patients, with 2188 receiving TSA and 2188 receiving HA, were included in the primary analyses. The HA cohort had a higher rate of any adverse event (7.18% vs 4.8%, P=.001), death (0.69% vs 0.1%, P=.004), sepsis (0.46% vs 0.1%, P=.043), postoperative transfusion (4.62% vs 2.2%, P<.001), postoperative intubation (0.5% vs 0.1%, P=.026), and extended length of stay (23.77% vs 13.1%, P<.001). HA was found to increase the odds of developing these complications when baseline demographics were controlled. Older age (odds ratio, 1.040; 95% CI, 1.021-1.059; P<.001) and lower body mass index (odds ratio, 0.949; 95% CI, 0.923-0.975; P<.001) increased the odds of having any adverse event in the HA cohort but not in the TSA cohort. Conclusion: Compared with TSA, HA appears to be associated with significantly higher rates of 30-day postoperative complications when performed for glenohumeral osteoarthritis. [Orthopedics. 2024;47(4):217-224.] [ABSTRACT FROM AUTHOR]

Background: Shoulder pain is one of the most important musculoskeletal conditions affecting the upper extremities. Glenohumeral osteoarthritis (GHOA) and rotator cuff injuries (RCIs) are notable for their high prevalence. The critical shoulder angle (CSA) is a significant radiological measure for determining the diagnosis and progression of patients with these conditions. Although there are reports in the international literature about this measure, in our country, guideline values considering these two pathologies are unknown. Objective: Our objective was to assess patients diagnosed with GHOA and RCI using an AP X-ray view and the CSA. Methods: To conduct this, we identified differences between sexes and age categories. Fifty-nine adult patients with GHOA and RCI were included. CSA grades varied depending on the age category and type of injury evaluated. Results: Significant differences between the age ranges of 40 and 54 (p = 0.05), 55–69 (p = 0.001), and 70–84 (p = 0.017) were observed. Conclusions: Patients with RCI tended to be younger and have a higher CSA compared to those with GHOA. It is important to have more normative values and to continue monitoring the critical shoulder angle in these patients. [ABSTRACT FROM AUTHOR]

Articular cartilage defects in the glenohumeral joint may be found in laborers, the elderly, and young athletes, among others. Various factors can contribute to cartilage damage, including prior surgery, trauma, avascular necrosis, inflammatory arthritis, joint instability, and osteoarthritis. There is a wide variety of treatment options, from conservative treatment, injections, and surgical options, including arthroscopic debridement, microfracture, osteochondral autograft transfer, osteochondral graft transplantation, autologous chondrocyte implantation, and the newly emerging techniques such as biologic augmentation. There is a challenge to determine the optimal treatment options, especially for young athletes, due to limited outcomes in the literature. However, there are many options which are viable to address osteochondral defects of the glenohumeral joint. [ABSTRACT FROM AUTHOR]

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

Steroid injections are a well-known first-line treatment for glenohumeral osteoarthritis; however, many patients eventually require definitive management with surgery. Recent literature has called into question the safety of steroid injections before shoulder surgery due to increased infections and revisions. Conclusive data regarding the relationship between preoperative injection and postoperative outcomes is lacking. This study aimed to determine the impact of ipsilateral injections on clinical outcomes following shoulder arthroplasty (SA). A retrospective study was performed on patients who underwent SA by a single fellowship-trained orthopedic surgeon from 2017 to 2021. Patients were divided into two cohorts based on preoperative corticosteroid injection: (1) injection group (IG) and (2) no injection (control group (CG)). The IG was further stratified based on number of injections (1 vs. ≥2 injections) and timing of injections relative to surgery (<3 months, 3-12 months, and >12 months). Patient-reported pain and satisfaction, simple shoulder test, shoulder pain and disability index, visual analog scale for pain, University of California-Los Angeles score, American Shoulder and Elbow Surgeons score, Constant-Murley score, range of motion, complications, and reoperations were collected preoperatively and at final follow-up. Comparisons were made between groups and the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were calculated for each score. 421 patients (IG = 98 patients, CG = 323 patients) were included, with mean follow-up of 22 months. The IG had more females (69.1% vs. 48.9%; P <.001) and older age (75 vs. 70; P <.001). There was significantly greater preoperative range of motion in the IG for forward elevation (80° vs. 70°; P =.025) and abduction (70° vs. 60°; P =.004). At final follow-up, all groups had a high percentage (mean 80.26%) of patients exceeding both MCID and SCB for all measures. More patients in the IG exceeded MCID and SCB for visual analog scale for pain (P =.009 and P =.007, respectively), and MCID for American Shoulder and Elbow Surgeons (P =.046) compared to the CG. The group with ≥2 injections reported worse shoulder pain and disability index scores (P =.024). Complication and reoperation rates were comparable between groups. Our study indicates that a single ipsilateral shoulder injection did not worsen postoperative outcomes or complication rates following SA. However, patients who received two or more injections had inferior patient-reported outcomes. Surgeons can continue to use injections as a viable first-line management option before shoulder arthroplasty for reliable pain relief without concerns for increased complications. [ABSTRACT FROM AUTHOR]

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

Glenohumeral joint osteoarthritis is prevalent in the middle-aged and elderly population, affecting approximately 16%-20% of individuals. Total shoulder arthroplasty has become a common treatment for osteoarthritis, with a notable rise in the use of reverse total shoulder arthroplasty (rTSA) over the past decade. Despite improvements in surgical technique and prostheses, 22% of patients continue to experience chronic pain following shoulder arthroplasty. Currently, medical practitioners lack a reliable method for identifying which patients will suffer from persistent pain and functional limitations after surgery. In this context, the neutrophil-to-lymphocyte ratio (NLR), known for measuring immune-inflammatory reactions and neuroendocrine stress, has gained significant attention. Therefore, the purpose of this study was to explore the predictive potential of the NLR in identifying patients who will experience elevated pain and functional limitations after primary rTSA. This study was a retrospective cohort design. Patient data were collected retrospectively between 2019 and 2021 and grouped based on preoperative NLR (≥2.5 and <2.5). Primary outcome measures assessed were the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS), Pittsburgh Sleep Quality Index, and Single Assessment Numeric Evaluation score. Secondary outcomes included active shoulder elevation and external rotation range of motion. Outcome measures were captured before surgery and at 6 and 12 months after surgery. At 6 months following surgery, patients with an NLR ≥2.5 scored significantly worse on the VAS (P =.0171), ASES (P =.0015), and Single Assessment Numeric Evaluation (P =.0226). Differences in Pittsburgh Sleep Quality Index scores were not significant (P =.2705). Forward elevation and external rotation range of motion were similar between groups at 6 months (P =.7777 and P =.2630, respectively). There was no statistically significant difference between groups at 12 months across all variables. Multivariate analysis showed that an NLR <2.5 had a significant positive effect on the ASES score (P =.0011) at 6 months after adjusting for age, gender, body mass index, depression, low back pain, and diabetes. Management of patients with chronic pain continues to be challenging with limited high-value interventions. Early identification of patients likely to have a protracted recovery following rTSA would allow for a multidisciplinary approach earlier in the recovery phase. Based on our results, patients who had a preoperative NLR value greater than 2.5 reported higher levels of pain, more functional limitations, and perceived poorer function at 6 months following rTSA. However, these effects were relatively small and not observed at the 12-month mark. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a painful, degenerative disease that affects the tissues of the joint spaces, such as the shoulder. Conventional medical treatment options, such as corticosteroid injections and anti-inflammatory medications, are not always sufficient to alleviate the symptoms from this disease. Low dose radiotherapy is a newer treatment option for patients with shoulder osteoarthritis and has shown positive outcomes. However, the problem is that there is a paucity of literature about treatment planning considerations for this new treatment option. The purpose of this case study was to provide an example of treatment planning techniques and considerations for shoulder osteoarthritis. Treatment techniques for shoulder LDRT, such as treatment field borders, prescribed dose, beam arrangements, appropriate beam energy, and special considerations are discussed. [ABSTRACT FROM AUTHOR]

Background: The primary cause of medium- to long-term complications in reverse shoulder arthroplasty (RSA) is the failure of the glenoid component. The purpose of this study was to evaluate both the achievement of planning through computer-assisted navigation and the clinical outcomes at a minimum follow-up (FU) of 12 months. Methods: From December 2019 to December 2022, 57 Equinoxe RSAs with computer-assisted navigation were performed. The average age was 72.8 ± 6.6 years. Using the Orthoblue software, the version and inclination of the glenoid were evaluated from a preoperative CT scan, and planning was performed. Intraoperative navigation data were evaluated, and the clinical outcomes were assessed at a minimum follow-up of 12 months. Results: The average follow-up was 30.7 ± 13.5 months. The planning was reproduced in all implants. No errors in the computer-assisted navigation system were detected. No intraoperative or postoperative complications were recorded. At the final FU, the average active anterior elevation was 143° ± 36°, external rotation was 34° ± 5°, QuickDASH score was 19 ± 16 points, and constant score was 77 ± 18. Conclusions: Computer-assisted navigation is a reliable system for positioning prosthetic implants on challenging glenoids. A longer follow-up period is necessary to confirm the reduction in postoperative complications and the increase in survival compared to traditional RSA. [ABSTRACT FROM AUTHOR]

B‐type glenoids are characterized by posterior humeral head migration and/or bony‐erosion‐induced glenoid retroversion. Patients with this type of osteoarthritic glenoids are known to be at increased risk of glenoid component loosening after anatomic total shoulder arthroplasty (aTSA). One of the main challenges in B glenoid surgical planning is to find a balance between correcting the bony shape and maintaining the quality of the bone support. This study aims to systematically quantify variabilities in terms of scapular morphology and bone mineral density in patients with B glenoids and to identify patterns of covariation between these two features. Using computed tomography scan images of 62 patients, three‐dimensional scapular surface models were constructed. Rigid and nonrigid surface registration of the scapular surfaces, followed by volumetric registration and material mapping, enabled us to develop statistical shape model (SSM) and statistical density model (SDM). Partial least square correlation (PLSC) was used to identify patterns of covariation. The developed SSM and SDM represented 85.9% and 56.6% of variabilities in terms of scapular morphology and bone density, respectively. PLSC identified four modes of covariation, explaining 66.0% of the correlation between these two variations. Covariation of posterior–inferior glenoid erosion with posterior sclerotic bone formation in association with reduction of bone density in the anterior and central part of the glenoid was detected as the primary mode of covariation. Identification of these asymmetrical distribution of bone density can inform us about possible reasons behind glenoid component loosening in B glenoids and surgical guidelines in terms of the compromise between bony shape correction and bone support quality. [ABSTRACT FROM AUTHOR]

(1) Background: Osteoarthritis is a degenerative joint disease that is commonly diagnosed in the aging population. Interestingly, the lower extremity joints have a higher published incidence of osteoarthritis than the upper extremity joints. Although much is known about the disease process, it remains unclear why some joints are more affected than others. (2) Methods: A comprehensive literature review was conducted utilizing the search engines PubMed, Google Scholar, and Elsevier from 2014 to 2024, directing our search to osteoarthritis of various joints, with the focus being on glenohumeral osteoarthritis. (3) Results and Discussion: The literature review revealed a publication difference, which may be explained by the inconsistency in classification systems utilized in the diagnosis of shoulder osteoarthritis. For instance, there are six classification systems employed in the diagnosis of glenohumeral osteoarthritis, making the true incidence and, therefore, the prevalence unobtainable. Furthermore, susceptibility to osteoarthritis in various joints is complicated by factors such as joint anatomy, weight-bearing status, and prior injuries to the joint. (4) Conclusions: This review reveals the lack of understanding of shoulder osteoarthritis's true incidence and prevalence while considering the anatomy and biomechanics of the glenohumeral joint. In addition, this is the first paper to suggest a single criterion for the diagnosis of glenohumeral osteoarthritis. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to compare outcomes in patients that underwent bilateral anatomic total shoulder arthroplasty (aTSA) vs. aTSA/ reverse total shoulder arthroplasty (rTSA) for rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA) to further elucidate the role of rTSA in this patient population. Methods: A single-institution prospectively collected shoulder arthroplasty database was reviewed for patients undergoing bilateral total shoulder arthroplasty (TSA) for RCI-GHOA with a primary aTSA and subsequent contralateral aTSA or rTSA. Outcome scores (SPADI, SST, ASES, UCLA, Constant) and active range of motion (abduction, forward elevation [FE], external and internal rotation [ER and IR]) were evaluated. Clinically relevant benchmarks (minimal clinically important difference [MCID], substantial clinical benefit [SCB], and patient acceptable symptomatic state [PASS]) were evaluated against values in prior literature. Incidence of surgical complications and revision rates were examined in qualifying patients as well as those without .05). The 2nd TSAs between groups were similar preoperatively, but aTSA/rTSA had superior outcome scores, overhead motion, and active abduction compared to patients that underwent aTSA/aTSA. There were no differences in active ER and IR scores or complication rates between groups. Conclusion: Patients with RCI-GHOA have excellent clinical outcomes after either aTSA/aTSA or aTSA/rTSA. [ABSTRACT FROM AUTHOR]

Background: An increased or decreased critical shoulder angle (CSA) is a known risk factor for osteoarthritis, lesions, and re-ruptures in the rotator cuff. A CSA greater than 35° correlates with degenerative rotator cuff tears, while a CSA of less than 30° correlates with osteoarthritis in the glenohumeral joint. The diagnostic gold standard for its determination is X-ray or MRI. Objectives: The primary objective of this research was to assess the viability of utilizing sonography imaging as a diagnostic tool to determine the modified critical shoulder angle (mCSA). This study aimed to investigate the feasibility and effectiveness of sonographic techniques in accurately diagnosing CSA compared to MRI. Study Design and Methods: A cohort study was carried out (level of evidence 3). The CSA (MRI) and the mCSA (ultrasound) were assessed retrospectively by two independent board-certified investigators in 109 patients with shoulder pain by MRI and musculoskeletal sonography. The CSA in the MRI dataset was determined using routine protocols and then compared to the values assessed using the modified sonography-assisted method (mCSA). Both results were analyzed with linear regression to determine a possible correlation. All investigations were performed by a DEGUM (German Society for Medical Ultrasound)-certified specialist in musculoskeletal sonography. Results: A total of 112 patients were included in this study, namely 40 female patients and 72 male patients with a mean age of 54.7 years at the time of the investigation. The mean CSA in MRI was 31.5° ± 3.899, and the mCSA in sonography was 30.1° ± 4.753. The inter- and intraobserver reliability for the CSA was factual with values of 0.993 and 0.967. The inter- and intraobserver reliability for mCSA was factual as well, with values of 0.989 and 0.948. The ANOVA analysis did not reveal a significant difference between the CSA and the mCSA values, and linear regression determined the R2 value to be 0.358 with p < 0.05. Conclusions: Diagnosing the mCSA using sonography is a safe and valid method. No statistically significant differences between the results in MRI and sonography could be seen. Although this is a retrospective, single-center study including only Caucasian mid-Europeans, and with the known limitations of ultrasound imaging, it nevertheless shows that sonography can be used as a simple, cheap, and fast technique to assess a modified CSA, which shows very good correlation with the standard CSA without losing the diagnostic quality. [ABSTRACT FROM AUTHOR]

The Frozen Shoulder is a frequently encountered pathology in clinical practice. This condition often coexists with various comorbidities and is characterized by severe pain and a significantly restricted motion of the affected shoulder. A limited passive external rotation with the arm in adduction, with no signs of any other pathology that could explain the finding, such as shoulder osteoarthritis or an undetected posterior dislocation, is pathognomonic. The course of the disease typically spans over one to two years and is usually self-limiting. In the vast majority of cases, this condition can be managed conservatively. [ABSTRACT FROM AUTHOR]

Anatomic total shoulder arthroplasty (aTSA) has historically been considered the gold-standard surgical strategy for patients with end-stage glenohumeral osteoarthritis (GHOA). However, reverse shoulder arthroplasty (RSA) is increasingly used for shoulders with GHOA with an intact rotator cuff due to concerns regarding late cuff failure, anatomic glenoid component loosening, and the impact of bone loss and severe soft-tissue balance in aTSA. With substantial differences in cost between aTSA and RSA, it remains unclear whether the increased risk of late rotator cuff dysfunction in older adults justifies the increased cost of RSA. Therefore, the objective of this study was to utilize a decision-analytic Markov model to 1) quantify the cost-effectiveness of aTSA vs. RSA in patients with GHOA and intact rotator cuff and 2) determine whether an age exists at which RSA is more cost-effective than aTSA. A Markov model was developed to determine accumulated costs and quality-adjusted life years (QALYs) over a lifetime horizon for patients with end-stage GHOA and an intact rotator cuff who undergo either aTSA or RSA. Costs, health utility values, and transition probabilities were derived from the published literature. Sensitivity analyses were performed to identify age cutoffs at which one treatment option is more cost-effective than the other. For the baseline case of a 72-year-old patient, aTSA resulted in 9.43 QALYs and $29,077 in accumulated costs, while RSA produced 9.44 QALYs at a total cost of $31,199 (incremental cost-utility ratio (ICER) comparing rTSA to aTSA: $188,222.94/QALY). Because the ICER for rTSA fell above the $50,000 willingness-to-pay (WTP) threshold, aTSA was determined to be the most cost-effective strategy for patients of this age. Within the age-based sensitivity analysis, RSA was the most cost-effective option for those 67 years of age or younger, while aTSA was the dominant strategy at 77 years and older, resulting in both equal QALYs and lower costs for patients in this age group. Based on this analysis, aTSA is a cost-effective treatment strategy for GHOA with an intact rotator cuff in adults over 67 years of age. For patients between the ages of 67 and 77, RSA resulted in marginally higher QALYs, but this increase was not enough to offset the increased costs to be considered cost-effective. In this model, RSA was cost-effective for individuals 67 years of age or younger. [ABSTRACT FROM AUTHOR]

Glenoid bone grafting is an option to correct severe glenoid retroversion and posterior bone loss in the setting of primary total shoulder arthroplasty (TSA). However, limited studies report the midterm outcomes of this procedure. This was a retrospective case series of patients undergoing TSA with an autologous humeral head glenoid bone graft by a single surgeon between 2004 and 2014. Outcome variables included preoperative and postoperative forward elevation, external rotation, internal rotation, visual analog scale score, American Shoulder and Elbow Surgeons score, and simple shoulder test score. Radiographic variables included the acromiohumeral interval and Lazarus glenoid loosening score. In total, 7 cases were included in our analysis. The mean age was 65.0 years (range 55-80), and the mean follow-up was 6.8 years (range 4.2-8.2). All patients had a diagnosis of osteoarthritis as the primary indication for surgery. The glenoid implant types were 2 pegged (28.6%) and 5 keeled (71.4%). The Walch glenoid classifications were 3 B2 (42.9%), 1 B3 (14.3%), and 3 with unavailable preoperative computed tomography scans (42.9%). Mean forward elevation, external rotation, visual analog scale, and American Shoulder and Elbow Surgeons all improved significantly from preoperative to postoperative. Mean internal rotation and simple shoulder test trended toward improvement. Radiographic glenoid loosening was observed in 1 patient, and 1 patient underwent revision to reverse TSA due to graft resorption and glenoid loosening at 8.3 years following the index procedure. Glenoid bone grafting is a viable option for patients requiring TSA with severe glenoid retroversion and posterior bone loss. Graft resorption and glenoid loosening remain concerns; however, the majority of patients in our study demonstrated significant improvement following their procedure. [ABSTRACT FROM AUTHOR]

Our understanding of the pathophysiology and natural history of glenohumeral osteoarthritis has improved greatly in recent decades. Modifications of existing classification systems, as well as new classification systems have been proposed based on this improved understanding. Given the difficulty and importance of accurate positioning of the glenoid component in shoulder arthroplasty, it is critical that surgeons have a comprehensive understanding of glenoid imaging modalities and classification systems, as well as the advantages and limitations of each. The purpose of this article is to review the history, evolution, and current usage of glenoid classification systems. Additionally, the role of imaging in glenoid classification, accuracy of different modalities, and the utility and implications of three-dimensional reconstruction and computer navigation technologies are discussed. [ABSTRACT FROM AUTHOR]

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

A recent study based on a large osteological collection reported an association between clavicle fractures and osteoarthritis of the glenohumeral joint. No clinical study has yet addressed this potential association. Other radiographic parameters such as the critical shoulder angle have been associated with the risk of glenohumeral joint osteoarthritis. The primary outcome of this study was to determine if there is an association between glenohumeral joint arthritis and clavicle fractures. The secondary outcome was to determine the association between critical shoulder angle and glenohumeral joint arthritis in our patient cohort. We retrospectively analysed 572 consecutive shoulder arthroplasty surgeries. Osteoarthritis was the indication for 343 shoulder arthroplasties. 229 shoulder arthroplasties were performed due to another diagnosis such as trauma or fracture, cuff arthropathy, or revision surgery. Three fellowship trained consultant shoulder surgeons assessed the pre- and post-operative radiographs of all patients. A clavicle fracture was suspected in 5/343 (1.5 %) shoulder arthroplasties performed due to osteoarthritis and 5/229 (2.1 %) shoulder arthroplasties performed for another diagnosis. Interobserver variability was assessed using a Fisher Exact test and showed no significant relationship between osteoarthritis and a fracture of the clavicle (p = 0.531). Critical shoulder angle results correlated with the previously published literature regarding critical shoulder angle and osteoarthritis and rotator cuff arthropathy. Clavicle fractures were not associated with glenohumeral osteoarthritis in our patient cohort of shoulder arthroplasty patients. Critical shoulder angle results were consistent with published literature. Further research in the form of prospective long term studies are needed to establish if any association exists between clavicle fractures and osteoarthritis of the glenohumeral joint. Level III. Retrospective analysis. [ABSTRACT FROM AUTHOR]

Background: Sacrifice of the latissimus dorsi (LD) muscle might entail donor site morbidity when used in delayed breast reconstruction. Previous studies are small, have short follow-up, and demonstrate diverging results. The aims of this study were to evaluate long-term patient-reported effects on shoulder and back function following LD flap harvest, and to investigate predictors for a worse outcome. Method: This is a retrospective observational case–control cohort study. Cases were all patients who had undergone an LD flap reconstruction during the years 2007–2017. Controls were patients reconstructed with a deep inferior epigastric perforator (DIEP) flap during the same time period. Participants completed two validated questionnaires; the BREAST-Q reconstruction LD domains and the Western Ontario Shoulder Osteoarthritis Index (WOOS). Results: A total of 135 cases (75 per cent) and 118 controls (60 per cent) responded to the questionnaires. The mean follow-up time was 7 years. Patients reconstructed with a LD flap were significantly less satisfied with their back and shoulder function when compared to the DIEP controls, as measured with BREAST-Q and WOOS. Predictors for a poor patient-reported back and shoulder function included axillary surgery and axillary radiotherapy, especially when combined, as well as higher age at reconstruction. Conclusion: Patients who have undergone LD flap for delayed breast reconstruction had a lower satisfaction with back and shoulder function, when compared to patients who had undergone a DIEP reconstruction. Delayed LD reconstruction should be used with care, especially in patients who have undergone axillary surgery and axillary radiotherapy. This is a retrospective observational case–control study, evaluating patient reported back and shoulder function 7 years after a breast reconstruction with latissimus dorsi reconstruction. Women with similiar age, BMI and radiation status were used as controls. The patients were statistically significantly less satisfied with their back and shoulder function when compared to the controls, as measured with BREAST-Q and WOOS. Axillary surgery was the only predictor that was statistically significantly associated with low satisfaction. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY The critical shoulder angle (CSA) is formed by the combination of glenoid inclination and acromial index and has been shown related to rotator cuff tears and glenohumeral osteoarthritis. SLAP lesions today have an important place among bicipitolabral pathologies that cause intensive shoulder pain. We aimed to investigate the relationship between CSA and glenoid depth and SLAP lesions. MATERIAL AND METHODS Between March 2017 and January 2022, 279 consecutive shoulder arthroscopy patients’ MRI images were retrospectively examined. After the exclusion criteria, 191 patients were eligible. Patients with SLAP lesions (n=37) were assembled as the study group (Group 1), and patients with intact superior labrum (n=154) were named as the control group (Group 2). Critical shoulder angle (CSA) and glenoid depth measurements were performed using the preoperative MRI images. RESULTS A total of 191 patients, of whom 84 were male (44%) were included. The mean age was 49.9±14.96 (range 18–79). There was a statistically significant difference between the SLAP group (Group 1) and the control group (Group 2) in terms of CSA (p=0.032). The mean CSA was 31.66°±3.51° in Group 1 and 33.57° ±5.01° in Group 2. The cut-off value for CSA in patients with SLAP lesions was calculated as 32.85° and the area under the curve was 0.61, therefore a satisfactory association was observed between the groups. The mean glenoid depth was 4.32 ±1.25 mm in Group 1, and 4.39 ±0.32 mm in Group 2. There was no statistically significant difference between the groups in terms of glenoid depth (p=0.136) and also no association between the glenoid depth and SLAP lesions was observed (cut-off=4.45 mm, AUC=0.32). CONCLUSIONS Low CSA is associated with SLAP lesions, just as in glenohumeral osteoarthritis. Further prospective clinical studies are needed to enlighten the predisposing effect of CSA to SLAP lesions and the success of superior labral repairs. [ABSTRACT FROM AUTHOR]

Anatomic total shoulder arthroplasty (TSA) is a common treatment choice for patients with advanced glenohumeral osteoarthritis and an intact rotator cuff. In the setting of B2 glenoid deformity, eccentric glenoid reaming with a TSA is a viable option; however, an increasing trend is to perform a reverse shoulder arthroplasty (RSA). The ideal implant choice for these patients is still uncertain. A retrospective review of an eccentrically reamed TSA (ER-TSA) cohort vs. a rotator cuff–preserving RSA (RCP-RSA) cohort performed from 2013 to 2021 was completed. Any patient with evidence of a B2 glenoid verified by preoperative computed tomography or magnetic resonance imaging was considered for inclusion. A retrospective review of patients' last clinical follow-up was performed and radiographic review of postoperative complications. All patients were then contacted by phone to determine if they underwent any revision surgery and to obtain American Shoulder and Elbow Surgeons (ASES) scores. In the ER-TSA cohort, 18 patients were identified and contacted for follow-up ASES questionnaire. The average age was 72. The average follow-up was 4.7 years, with an average clinic follow-up period of 15 months. The delta range of motion (ROM) for forward flexion was +35° improvement, for abduction was +17°, and for external rotation was +23°. The average ASES score was 87. For the RCP-RSA cohort, 17 patients were identified and contacted for ASES questionnaire with 19 total shoulders. The average age was 75. The average follow-up was 2.5 years, with an average clinic follow-up period of 18 months. The delta ROM for forward flexion was +53° improvement, for abduction was +61°, and for external rotation was +23°. The average ASES score was 93. In the present cohorts of ER-TSA vs. RCP-RSA for glenohumeral osteoarthritis with an intact rotator cuff and B2 glenoid deformity in patients 65+ years old, there were no revisions, and overall patients reported an ASES score of 87 for ER-TSA and 93 for RCP-RSA. This study demonstrates that both ER-TSA and RCP-RSA remain a viable option, however it also shows that RCP-RSA has better early to midterm patient-reported outcome measures, the ability to account for worse posterior glenoid deformity, and has greater overall improvement in ROM in such a commonly encountered patient population. [ABSTRACT FROM AUTHOR]

Reverse shoulder arthroplasty (RSA) has transformed the management of shoulder pathologies, including cuff tear arthropathy and osteoarthritis. The innovative design principles of RSA, such as the medialization and inferiorization of the joint center of rotation, distalization of the humerus, and a semi-constrained construct, enable effective deltoid compensation for rotator cuff deficiency. The Grammont-style RSA demonstrated excellent clinical outcomes. However, complications like instability and scapular notching prompted the exploration of lateralized designs. The radiographic evaluation of RSA is paramount for understanding the biomechanics of the implant and to foresee possible complications. Radiographic assessments encompass glenoid and humeral component positions, identifying features like scapular notching, radiolucent lines, heterotopic ossifications, bone adaptations, and humeral lengthening. Lateralized designs alter muscle moment arms and improve deltoid efficiency, influencing abduction and adduction mechanics. Despite the reduction in scapular notching, lateralized RSA introduces new challenges, such as increased risk of scapular spine and acromial fractures. Understanding the radiographic features and biomechanics of lateralized RSA is crucial for optimizing patient outcomes and mitigating potential complications. [ABSTRACT FROM AUTHOR]

Background: Walch B2 glenoids present unique challenges to the shoulder arthroplasty surgeon, particularly in young, active patients who may wish to avoid the restrictions typically associated with an anatomic total shoulder arthroplasty (TSA). Long-term data are limited when comparing hemiarthroplasty (HA) and TSA for patients with an intact rotator cuff. The purpose of our study was to compare the long-term outcomes of HA vs. TSA in a matched analysis of patients with B2 glenoids, primary osteoarthritis (OA), and an intact rotator cuff. Methods: A retrospective review was performed of all patients who underwent HA or TSA between January 2000 and December 2011 at a single institution. Inclusion criteria were primary OA, Walch B2 glenoid morphology, an intact rotator cuff intraoperatively, at least 2 years of clinical follow-up, or revision within 2 years of surgery. Fifteen HAs met inclusion criteria and were matched 1:2 with 30 TSAs using age, sex, body mass index, and implant selection. Clinical outcomes including range of motion (ROM), visual analog scale (VAS) for pain, subjective shoulder value score, American Shoulder and Elbow Surgeons (ASES) score, complications, and revisions were recorded. Postoperative radiographs were reviewed to assess for stem loosening, humeral head subluxation, glenoid loosening, and glenoid erosion. Results: A total of 15 HAs and 30 TSAs met inclusion criteria at a mean follow-up of 9.3 years. The mean age at the time of surgery was 60.2 years for HA and 65.4 years for TSA (P = .08). Both cohorts had significant improvements in ROM, subjective shoulder value, and VAS pain scores (P < .001). TSA had higher postoperative ASES scores compared to HA (P = .03) and lower postoperative VAS pain scores (P = .03), although the decrease in pain from preoperatively to final follow-up was not significantly different between HA and TSA (P = .11). HAs were more likely to have posterior humeral subluxation (P < .001) and stem lucencies (P = .02). Revisions occurred in 11.1% of the cohort with no difference for HA and TSA (P = .73). Conclusions: At nearly 10 years of follow-up, HA and TSA both showed significant improvements in ROM and pain when performed for primary glenohumeral OA in B2 glenoids with intact rotator cuffs. Compared to HA, TSAs had less posterior humeral subluxation, less stem lucencies, higher ASES scores, and lower postoperative VAS pain scores. However, our study failed to demonstrate a difference in ROM, complication, or revision rates between HA and TSA.

Introduction: As the prevalence of sleep apnea (SA) increases nationwide, large sample sized studies following primary reverse shoulder arthroplasty (RSA) in SA patients are scarce. Therefore, this study evaluated whether SA is associated with 1) longer in-hospital lengths of stay (LOS) 2) readmissions 3) medical complications and 4) costs. Methods: A retrospective nationwide Medicare analysis from 2005 to 2014 was performed. Inclusion criteria were patients with SA undergoing RSA for the treatment of glenohumeral osteoarthritis. Study group patients were 1:5 ratio matched to controls yielding 6241 patients in the study and 31,179 in the comparison cohort. Logistic regression was used to calculate odds-ratios (OR) for readmissions and complications. A p- value less than 0.004 was significant. Results: SA patients had significantly longer in-hospital LOS compared to their counterparts (3-days versus 2-days, p < 0.0001), but similar rates of 90-day readmissions (7.98% vs. 6.54%; OR: 1.00, p = 0.907). Patients with SA had significantly greater incidence and odds of 90-day medical complications (13.36% vs. 7.29%; OR: 1.42, p < 0.0001) and significantly higher 90-day costs ($16,529.16 vs. $14,789.15, p < 0.0001). Conclusion: Patients with SA undergoing primary RSA for the treatment of glenohumeral OA have longer in-hospital LOS, increased medical complications, and costs of care. Readmissions were not more common. Level of Evidence: III [ABSTRACT FROM AUTHOR]

Background: Virtual Reality (VR) systems have been increasingly used across several medical fields. A crucial preliminary step for developing optimized VR-based applications for rehabilitation purposes is identifying potential interventions to meet the requirements necessary to satisfy end-users' needs. This study aims to assess the acceptability, usability, and appropriateness of a VR physical therapy program executed with Oculus Quest 2 by expert physiotherapists of shoulder musculoskeletal rehabilitation. Methods: Eleven physiotherapists were enrolled to test a VR program for shoulder musculoskeletal rehabilitation. At the end of each session, physiotherapists completed three questionnaires about the acceptability, usability, and appropriateness of the VR system and application, investigating aspects such as wearability, safety, stability, ease of control, comfort, size, utility, playability, and use mode. Results: The acceptability questionnaire revealed that all the physiotherapists found the VR system easy to wear and control, very confident, and safe. The usability questionnaire showed that most physiotherapists (73%) found the VR application entertaining, although only 45% said the system could be used independently by patients without the support of a therapist. Many physiotherapists found the use of the VR application appropriate for patients with rotator cuff tears treated conservatively (63.6%) or surgically (54.5%), for patients with shoulder osteoarthritis treated conservatively (72.7%), for patients with shoulder osteoarthritis after surgical treatment (63.6%). 91% of physiotherapists think it would be best for patients to use the VR system under the supervision of a therapist and not independently in a home setting. Conclusions: The use of VR in orthopaedic rehabilitation is encouraging, although further efforts are needed to increase the independent use of patients without the supervision of a physiotherapist. Moreover, future studies should strive to ensure the clinical effectiveness of VR rehabilitation in reaching therapeutic goal settings. [ABSTRACT FROM AUTHOR]

Symptomatic primary glenohumeral (GH) joint osteoarthritis (OA) can be challenging to treat. Hyaluronic acid (HA) has emerged as a promising treatment for the nonsurgical management of GH‐OA. In this systematic review with meta‐analysis, we aimed to evaluate the current evidence regarding the efficacy of intra‐articular HA on pain relief in patients suffering from GH‐OA. A total of 15 studies (only randomized controlled trials providing data at the end of the intervention) were included. The relevant studies were selected based on the following PICO model: P: patients with diagnosis of shoulder OA; I: HA infiltrations as therapeutic intervention administered; C: no restriction for comparators assessed; O: pain, in terms of visual analog scale (VAS) or numeric rating scale. The risk of bias among the included studies was estimated using the PEDro scale. A total of 1023 subjects were analyzed. Comparing HA injections combined with physical therapy (PT) compared to PT alone resulted in superior scores, showing an overall effect size (ES) of 4.43 (p = 0.00006). Moreover, pooled analysis of VAS pain scores demonstrated a significant improvement in the ES of the HA in comparison with corticosteroid injections (p = 0.002). On average, we reported a PEDro score of 7.2. A total of 46.7% of studies showed probable signs of a randomization bias. The findings of this systematic review and meta‐analysis showed that IA injections of HA might be effective on pain relief with significant improvements compared to baseline and compared to corticosteroid injections in patients affected by GH‐OA. [ABSTRACT FROM AUTHOR]

Glenohumeral osteoarthritis (GHOA) is a widely prevalent disease with increasing frequency due to population aging. Both clinical manifestations and radiography play key roles in the initial diagnosis, staging, and management decisions. Radiographic disease progression evaluation is performed using validated staging systems, such as Kellgren and Lawrence, Samilson, and Hamada. For young patients with mild to moderate GHOA and failed conservative treatment, arthroscopic preservation surgery (APS) is usually considered. Older patients and those with severe GHOA benefit from different types of arthroplasties. Preoperative magnetic resonance imaging (MRI) is essential for APS surgical planning, as it maps repairable labral, cartilage, and rotator cuff lesions. For arthroplasty planning, the status of glenoid cartilage and intactness of rotator cuff as well as glenoid morphology represent key factors guiding the decision regarding the most suitable hardware design, whether resurfacing, partial, total, or reverse joint replacement. Pre-surgical MRI or alternatively computed tomography arthrogram is employed to evaluate the cartilage and rotator cuff. Finally, three-dimensional computed tomography (3D CT) is indicated to optimally assess the glenoid morphology (to determine Walch classification, version, inclination, and bone loss) and analyze the necessity for glenoid osteotomy or graft augmentation to correct the glenoid structural abnormalities for future success and longevity of the shoulder implants or chosen constructs. Understanding the purpose of each imaging and treatment modality allows more efficient image interpretation. This article reviews the above concepts and details what a surgeon needs from a radiologist and could benefit from accurate reporting of preoperative imaging studies. [ABSTRACT FROM AUTHOR]