Is the use of abduction pillows crucial for post-operative rehabilitation following reverse total shoulder arthroplasty?

Background: Surgeons often use abduction pillows after reverse total shoulder arthroplasty (rTSA), but evidence for their benefits is limited. This study compares outcomes for patients using a sling with or without an abduction pillow post-operatively.

Methods: A retrospective review was conducted on patients undergoing primary rTSA.

Coronal plane deformity in total knee arthroplasty is associated with increased operative time and disposition to skilled nursing facility.

Purpose: Studies demonstrate similar long-term Total Knee Arthroplasty (TKA) outcomes in patients with significant versus minimal preoperative coronal plane deformity. Limited short-term outcomes data, which determine costs of care, exist.

Methods: We retrospectively explored the impact of preoperative coronal plane deformity on operative time, length of stay (LOS), and discharge to skilled nursing facility (SNF) in TKA.

Public Knowledge and Perception of Outpatient Shoulder Arthroplasty.

There is a growing trend in performing outpatient total shoulder arthroplasty (TSA). The purpose of this study was to analyze the public perception of outpatient TSA by querying a validated online market research platform regarding the public's knowledge, expectations, and beliefs on outpatient TSA. One thousand eighty respondents completed the survey in 2021.

Shoulder injury patterns and trends in the national football league: an epidemiological analysis.

Background: Athletic movements in American football render the shoulder vulnerable to injury. The aim of this study was to explore the epidemiology of shoulder injuries in the National Football League (NFL).

Methods: Injury data from the 2019-2022 seasons were extracted from official NFL website and secondary resources.

Outpatient versus inpatient total shoulder arthroplasty: A meta-analysis of clinical outcomes and adverse events.

Background: In recent years, orthopaedic procedures have increasingly shifted from inpatient to outpatient settings. This trend includes total shoulder arthroplasty (TSA), which is being performed more frequently in outpatient facilities and ambulatory surgical centres. The purpose of this study was to compare the clinical outcomes and rates of adverse events between outpatient and inpatient TSA.

Reverse versus anatomic total shoulder arthroplasty for glenohumeral osteoarthritis with intact cuff: a meta-analysis of clinical outcomes.

Background: Anatomic and reverse total shoulder arthroplasty (RSA) (total shoulder arthroplasty [TSA]) have surged in popularity in recent years. While RSA is Food and Drug Administration approved for cases of rotator cuff tear arthropathy, indications have expanded to include, among others, primary glenohumeral osteoarthritis (GHOA).

Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were queried through November 2023.

Validation of a Discharge Risk Calculator for Rural Patients Following Total Joint Arthroplasty.

Background: As the volume of total joint arthroplasty in the US continues to grow, new challenges surrounding appropriate discharge surface. Arthroplasty literature has demonstrated discharge disposition to postacute care facilities carries major risks regarding the need for revision surgery, patient comorbidities, and financial burden. To quantify, categorize, and mitigate risks, a decision tool that uses preoperative patient variables has previously been published and validated using an urban patient population.

Association between radiographic soft-tissue thickness and increased length of stay, operative time, and infection rate after reverse shoulder arthroplasty.

Background: Reverse shoulder arthroplasty (RSA) is a widely performed surgical procedure to address various shoulder pathologies. Several studies have suggested that radiographic soft-tissue thickness may play a role in predicting complications after orthopedic surgery, but there have been limited studies determining the use of radiographic soft-tissue thickness in RSA. The purpose of this study was to evaluate whether radiographic soft-tissue thickness could predict clinical outcomes after RSA and compare the predictive capabilities against body mass index (BMI).

Trends in outcomes following aseptic revision shoulder arthroplasty.

Purpose: As the incidence of anatomic and reverse total shoulder arthroplasty (TSA, RSA) increases, revision procedures will also increase with a corresponding need for counseling patients regarding outcomes. We hypothesized that different revision categories would have different complication profiles depending on both the indication as well as the nature of the prior hardware.

Methods: A retrospective review of 1773 cases performed at a single tertiary health system utilized case postings and diagnoses to identify revision shoulder arthroplasty cases.

Transitioning to Outpatient Shoulder Arthroplasty: Safety, Efficiency, and Cost in a Diverse Payer Mix.

Outpatient shoulder arthroplasty presents potential clinical benefits but also risk without perioperative optimization. Length of stay depends largely on surgeon preferences, and a large single-surgeon cohort may provide insight into optimal strategies and costs for outpatient shoulder arthroplasty. A single-surgeon cohort of 472 anatomic and reverse shoulder arthroplasties performed between 2017 and 2020 was retrospectively reviewed.

A Validated Pre-operative Risk Prediction Tool for Extended Inpatient Length of Stay Following Primary Total Hip or Knee Arthroplasty.

Background: As value-based reimbursement models mature, understanding the potential trade-off between inpatient lengths of stay and complications or need for costly postacute care becomes more pressing. Understanding and predicting a patient's expected baseline length of stay may help providers understand how best to decide optimal discharge timing for high-risk total joint arthroplasty (TJA) patients.

Methods: A retrospective review was conducted of 37,406 primary total hip (17,134, 46%) and knee (20,272, 54%) arthroplasties performed at two high-volume, geographically diverse, tertiary health systems during the study period.

A validated preoperative risk prediction tool for extended inpatient length of stay following anatomic or reverse total shoulder arthroplasty.

Background: Recent work has shown inpatient length of stay (LOS) following shoulder arthroplasty to hold the second strongest association with overall cost (after implant cost itself). In particular, a preoperative understanding for the patients at risk of extended inpatient stays (≥3 days) can allow for counseling, optimization, and anticipating postoperative adverse events.

Methods: A multicenter retrospective review was performed of 5410 anatomic (52%) and reverse (48%) total shoulder arthroplasties done at 2 large, tertiary referral health systems.

Concordance of Preoperative 3D Templating in Stemless Anatomic Total Shoulder Arthroplasty.

Introduction: Recent advances in preoperative 3D templating software allow surgeons to plan implant size and position for stemless total shoulder arthroplasty (TSA). Whether these preoperative plans accurately reflect intraoperative decisions is yet unknown, and the purpose of this study was to evaluate concordance between planned and actual implant sizes in a series of patients undergoing stemless TSA.

Methods: A retrospective cohort of consecutive, anatomic, stemless TSA cases performed by two surgeons between September 2019 and February 2021 was examined.

Perioperative pain control represents the primary concern for patients considering outpatient shoulder arthroplasty: a survey-based study.

Background: Outpatient (OP) total shoulder arthroplasty (TSA) with same-day discharge can now be performed safely in appropriately selected patients. Patient knowledge and perspectives regarding OP TSA are yet unknown and such information may inform surgeon decision-making and provide a framework for addressing patient concerns. The goal of this study was to understand and quantify patient knowledge of and concerns for OP TSA, with a working hypothesis that majority of patients are unaware of OP TSA as a realistic option and that their primary concern would be postoperative pain control.

Validation of a Predictive Tool for Discharge to Rehabilitation or a Skilled Nursing Facility After TJA.

Background: Cost excess in bundled payment models for total joint arthroplasty (TJA) is driven by discharge to rehabilitation or a skilled nursing facility (SNF). A recently published preoperative risk prediction tool showed very good internal accuracy in stratifying patients on the basis of likelihood of discharge to an SNF or rehabilitation. The purpose of the present study was to test the accuracy of this predictive tool through external validation with use of a large cohort from an outside institution.

Fracture Severity Based on Neer Classification Does Not Predict Short-term Complications Following Reverse Shoulder Arthroplasty.

Proximal humerus fractures (PHF) are common in elderly and osteoporotic patients, and these fractures are often described using the Neer classification. As reverse shoulder arthroplasty (RSA) for PHF becomes more common, it is helpful to identify the utility of Neer classification in predicting postoperative outcomes for patients undergoing RSA. The medical records of patients undergoing primary RSA for PHF at a single academic institution from 2013-2019 were identified using medical billing codes.

Simple preoperative radiographic and computed tomography measurements predict adequate bone quality for stemless total shoulder arthroplasty.

Introduction: Although there is increased utilization of stemless humeral implants in anatomic total shoulder arthroplasty (TSA), there are inadequate objective metrics to evaluate bone quality sufficient for fixation. Our goals are to: (1) compare patient characteristics in patients who had plans for stemless TSA but received stemmed TSA due to intraoperative assessments and (2) propose threshold values of bone density, using the deltoid tuberosity index (DTI) and proximal humerus Hounsfield units (HU), on preoperative X-ray and computed tomography (CT) to allow for preoperative determination of adequate bone stock for stemless TSA.

Methods: This is an observational study conducted at an academic institution from 2019 to 2021, including consecutive primary TSAs templated to undergo stemless TSA based on 3-dimensional CT preoperative plans.

Interscalene block with liposomal bupivacaine versus continuous interscalene catheter in primary total shoulder arthroplasty.

Background: Multimodal pain regimens in total shoulder arthroplasty (TSA) now include regional anesthetic techniques. Historically, regional anesthesia for extended postoperative pain control in TSA was administered using a continuous interscalene catheter (CIC). Liposomal bupivacaine (LB) is used for its potential for similar pain control and fewer complications compared with indwelling catheters.

Influence of medical comorbidity and surgical indication on total elbow arthroplasty cost of care.

Background: Movement toward providing value-based musculoskeletal care requires understanding the cost associated with surgical care as well as the drivers of these costs. The aim of this study was to investigate the effect of common medical comorbidities and specific total elbow arthroplasty (TEA) indications on reimbursement costs throughout the 90-day TEA episode of care. The secondary aim was to identify the drivers of these costs.

Is Advanced Imaging to Assess Rotator Cuff Integrity Before Shoulder Arthroplasty Cost-effective? A Decision Modeling Study.

Background: Shoulder arthroplasty is increasingly performed for patients with symptoms of glenohumeral arthritis. Advanced imaging may be used to assess the integrity of the rotator cuff preoperatively because a deficient rotator cuff may be an indication for reverse shoulder arthroplasty (RSA) rather than anatomic total shoulder arthroplasty (TSA). However, the cost-effectiveness of advanced imaging in this setting has not been analyzed.

Early aseptic reoperation after shoulder arthroplasty increases risk of subsequent prosthetic joint infection.

Background: Despite the success of anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), the clinical course of some patients necessitates operative intervention in the acute postoperative period. In this study, we evaluate the risk of subsequent prosthetic joint infection (PJI) in patients who undergo an aseptic reoperation within 90 days of primary shoulder arthroplasty.

Method: A retrospective review of patients with primary TSA and RSA was performed using a commercially available national database (PearlDiver Inc.

Intraoperative fractures in shoulder arthroplasty: risk factors and outcomes.

Background: The incidence of shoulder arthroplasty in the United States continues to increase, and while the risk of intraoperative complications such as fracture remains relatively low, there has been little investigation into whether certain patient-specific risk factors predispose to this complication. This study characterizes the incidence of intraoperative fracture during shoulder arthroplasty and additionally hypothesizes that certain risk factors may exist in addition to potentially leading to worsened near-term outcomes.

Methods: An institutional database of shoulder arthroplasties (N = 1773; 994 anatomic, 779 reverse) was retrospectively reviewed, and the operative reports for each case were examined for documentation of an intraoperative fracture, including during which surgical step the fracture took place.

Why Do Patients Undergoing Extremity Prosthetic Reconstruction for Metastatic Disease Get Readmitted?

Background: Orthopedic oncology patients are particularly susceptible to increased readmission rates and poor surgical outcomes, yet little is known about readmission rates. The goal of this study is to identify factors independently associated with 90-day readmission for patients undergoing oncologic resection and subsequent prosthetic reconstruction for metastatic disease of the hip and knee.

Methods: This is a retrospective comparative cohort study of all patients treated from 2013 to 2019 at a single tertiary care referral institution who underwent endoprosthetic reconstruction by an orthopedic oncologist for metastatic disease of the extremities.