Survivorship of a Medialized Glenoid and Lateralized Onlay Humerus Reverse Shoulder Arthroplasty Is High at Midterm Follow-up.

Background: Reverse shoulder arthroplasty (RSA) is a common treatment of a variety of disabling shoulder conditions. The purpose of this study was to determine revision-free survivorship after RSA using a medialized glenoid and lateralized onlay-type humerus implant and to identify etiologies of revision.

Methods: All RSAs performed using the Comprehensive Reverse Shoulder System (Zimmer Biomet, Inc.

Cerebral Oxygenation in the Sitting Position Is Not Compromised During Spontaneous or Positive-Pressure Ventilation.

Background: General anesthesia with neuromuscular blockade may facilitate total shoulder arthroplasty but appears to increase risk of cerebral oxygen desaturation. Cerebral desaturation is undesirable and is a proxy for risk of stroke.

Purposes/questions: This study tested the hypothesis that cerebral oxygen desaturation occurs frequently during general anesthesia with neuromuscular blockade and positive-pressure ventilation but does not occur with spontaneous ventilation.

Acromion Compromise Does Not Significantly Affect Clinical Outcomes After Reverse Shoulder Arthroplasty: A Matched Case-Control Study.

Background: The effect of a pre-operative compromised acromion on reverse shoulder arthroplasty (RSA) is not well-studied.

Purposes/questions: We sought to determine the effect of a pre-operative compromised acromion on outcomes following RSA.

Methods: We conducted a retrospective case-control study of consecutive patients who underwent RSA over a 6-year period (June 2007 to June 2013) with a diagnosis of rotator cuff tear arthropathy.

Rotator cuff tendon calcific tendinitis treatment algorithm for primary care musculoskeletal physicians.

Purpose: Calcific tendinitis of the shoulder is a common pathology encountered by primary care sports medicine physicians and orthopedic surgeons. Understanding the patient demographics responsible for calcific tendinitis outcomes from various treatment modalities may lead to greater understanding of appropriate management.

Methods: This was a retrospective study on patients who were diagnosed with calcific tendinitis by imaging (radiographs, MRIs) at our institution from 2014 to 2016.

The pathogenesis and management of cuff tear arthropathy.

Massive rotator cuff tears may lead to the development of cuff tear arthropathy (CTA). Although this pathology has been recognized for more than 150 years, treatment strategies have continued to evolve. During the last decade, there has been increased understanding of the molecular and cellular changes that govern rotator cuff tear outcomes and development of new treatment strategies to repair or reconstruct the rotator cuff.

Patient-Specific Implants in Severe Glenoid Bone Loss.

Complex glenoid bone deformities present the treating surgeon with a complex reconstructive challenge. Although glenoid bone loss can be encountered in the primary setting (degenerative, congenital, post-traumatic), severe glenoid bone loss is encountered in most revision total shoulder arthroplasties. Severe glenoid bone loss is treated with various techniques including hemiarthroplasty, eccentric reaming, and glenoid reconstruction with bone autografts and allografts.

Risk factors for failing to achieve improvement after anatomic total shoulder arthroplasty for glenohumeral osteoarthritis.

Background: Although anatomic total shoulder arthroplasty (TSA) successfully improves pain and function, not all patients improve clinically. This study was conducted to determine patient-related factors for failure to achieve improvement after primary TSA for osteoarthritis at 2 years postoperatively.

Methods: This prospective study reviewed an institutional shoulder registry for consecutive patients who underwent primary TSA for osteoarthritis from 2007 to 2013 with baseline and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form scores.

Clinical Outcomes After Reverse Shoulder Arthroplasty With and Without Subscapularis Repair: The Importance of Considering Glenosphere Lateralization.

Introduction: Recent biomechanical data suggests that repairing the subscapularis during reverse shoulder arthroplasty (RSA) can increase the force required by the posterior rotator cuff and deltoid to elevate the arm.

Methods: We retrospectively studied patients who underwent primary RSA and had baseline and minimum 2-year postoperative American Shoulder and Elbow Surgeons (ASES) shoulder scores, stratified them according to subscapularis management, then subgrouped them according to lateralization of the glenosphere component.

Results: Patients with subscapularis repair and a lateralized glenosphere had significantly less improvement in ASES scores than did those without lateralization (P = 0.

Functional Outcomes of Modular Conversion of Hemiarthroplasty or Total to Reverse Total Shoulder Arthroplasty.

Background: The advent of modular shoulder arthroplasty systems has allowed the conversion of hemiarthroplasty or total shoulder arthroplasty to reverse total shoulder arthroplasty (RTSA) without removing a well-fixed stem.

Questions/purposes: To determine the feasibility, functional outcome, and complication profile of RTSA modular conversion.

Methods: A prospective shoulder arthroplasty registry was queried for consecutive patients scheduled for a modular conversion from January 1, 2007, to April 1, 2015.

Retrieval Analysis of Porous Titanium Glenoid Posts: An Evaluation of Osteointegration.

Glenoid component loosening is a commonly encountered complication of total shoulder replacements. Therefore, focus has been placed on glenoid fixation. Porous metal implants, which promote biological fixation through osteointegration, have provided an uncemented alternative to the traditional cemented implant.

Novel Solution for Massive Glenoid Defects in Shoulder Arthroplasty: A Patient-Specific Glenoid Vault Reconstruction System.

Complex glenoid deformities present the most difficult challenges in shoulder arthroplasty. These deformities may be caused by severe degenerative or congenital deformity, posttraumatic anatomy, tumor, or, in most cases, bone loss after glenoid failure in anatomical total shoulder arthroplasty. Methods of treating severe bone loss have included inlay and onlay bone-graft options with augmented fixation and, in severe cases, salvage hemiarthroplasty with limited goal expectations.

Depression and Patient-Reported Outcomes Following Total Shoulder Arthroplasty.

Background: Recent studies have found that depression is associated with increased pain and impairment following lower-extremity arthroplasty; however, this association has not been investigated for total shoulder arthroplasty. The objective of this study was to investigate the association between depression and patient-reported outcomes following total shoulder arthroplasty.

Methods: A prospectively collected institutional registry was queried for consecutive patients who underwent total shoulder arthroplasty for osteoarthritis from 2007 to 2013 with baseline and minimum 2-year postoperative American Shoulder and Elbow Surgeons (ASES) scores.

Staged bilateral total shoulder arthroplasty: improved outcomes with less than 6 months between surgeries.

Background: Research on optimal timing of bilateral anatomic total shoulder arthroplasty (TSA) is lacking. The purpose of this study was to investigate functional outcomes in patients undergoing bilateral anatomic TSA to understand the ideal timing for the second arthroplasty.

Methods: Patients who underwent bilateral TSA for osteoarthritis between 2000 and 2012 with a minimum follow-up of 12 months since their most recent surgery were evaluated.

Effect of Metabolic Syndrome and Obesity on Complications After Shoulder Arthroplasty.

Metabolic syndrome can adversely affect surgical outcomes. This study evaluated the postoperative outcomes of patients with metabolic syndrome after total shoulder arthroplasty (TSA). A retrospective cohort study of 4751 patients undergoing TSA was conducted with use of the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2013.

Causes of poor postoperative improvement after reverse total shoulder arthroplasty.

Background: Although reverse total shoulder arthroplasty (RTSA) has been successful in improving pain and function in most patients, some patients fail to improve clinically. The present study used a large registry of RTSA patients to evaluate associations between patient-related factors and poor postoperative improvement after RTSA.

Materials And Methods: A prospectively collected shoulder arthroplasty registry was queried for consecutive patients who underwent RTSA from 2007 to 2013.

Scapular Notching.

Developed in 1985, the Grammont-style reverse total shoulder arthroplasty offered a biomechanical advantage for the deltoid muscle as well as predictably reduced pain and improved shoulder function in rotator cuff-deficient shoulders. Despite favorable outcomes, reverse total shoulder arthroplasty is associated with a unique set of complications, one of which is scapular notching. Scapular notching is believed to be a result of mechanical impingement of the humeral component on the lateral scapular pillar.

Arthroplasty for the surgical management of complex proximal humerus fractures in the elderly: a cost-utility analysis.

Background: Shoulder hemiarthroplasty (HA) has been the standard treatment for complex proximal humerus fractures in the elderly requiring surgery but not amenable to fixation. Reverse total shoulder arthroplasty (RTSA) has also emerged as a costly albeit highly effective alternative. The purpose of this study was to compare the cost-effectiveness of nonoperative fracture care, HA, and RTSA for complex proximal humerus fractures from the perspective of both U.

Hemiarthroplasty Versus Total Shoulder Arthroplasty for Shoulder Osteoarthritis: A Matched Comparison of Return to Sports.

Background: Return to activity is a commonly used indication for shoulder hemiarthroplasty (HA) compared with total shoulder arthroplasty (TSA). Despite clinical studies demonstrating better functional outcomes after TSA, the literature has failed to show a difference in return to sports.

Purpose: To compare rates of return to sports in a matched cohort of TSA and HA patients with a preoperative diagnosis of glenohumeral osteoarthritis (OA).

Buprenorphine, Clonidine, Dexamethasone, and Ropivacaine for Interscalene Nerve Blockade: A Prospective, Randomized, Blinded, Ropivacaine Dose-Response Study.

Objective: This study investigated interscalene block for shoulder arthroplasty with various ropivacaine concentrations in the presence of clonidine, dexamethasone, and buprenorphine. The goal was prolonged analgesia with minimal motor blockade.

Design: Prospective, double-blind, randomized controlled trial.

Reverse Total Shoulder Arthroplasty and Work-Related Outcomes.

The average retirement age is increasing, and the indications for reverse total shoulder arthroplasty (RTSA) are being broadened. The goal of the current study was to determine objective findings for rate of return to work and time to return to work after RTSA. The authors performed retrospective data collection for consecutive patients who underwent RTSA at their institution between 2007 and 2013.

Sports- and Work-Related Outcomes After Shoulder Hemiarthroplasty.

Background: With an active aging population, more patients expect to return to previous activities and work after surgery.

Purpose: To determine the rate and timing to return of sports and employment after shoulder hemiarthroplasty.

Study Design: Case series; Level of evidence, 4.

Malnutrition: a marker for increased complications, mortality, and length of stay after total shoulder arthroplasty.

Background: Malnutrition is an established risk factor for postoperative complications. The purpose of this investigation was to determine the overall prevalence of malnutrition in total shoulder arthroplasty (TSA) patients, the differences in prevalence across obesity subgroups, and the overall complication risk of malnourished patients compared with normal patients.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for TSA cases from 2005 to 2013 for this retrospective cohort study.

No differences in early results of a hybrid glenoid compared with a pegged implant.

Background: Glenoid component loosening after total shoulder arthroplasty is one of the most common causes of failure. A hybrid glenoid that uses peripherally cemented pegs and a central press-fit post may improve implant longevity.

Questions/purposes: We asked, compared with polyethylene pegged glenoid implants, do hybrid glenoid implants with a titanium post provide (1) better ingrowth with fewer radiolucencies, (2) better outcome and pain scores, and (3) lower risk of complications and revisions?

Methods: Between 2009 and 2010, 126 patients underwent primary total shoulder arthroplasty for osteoarthritis.

Patient Activity Levels After Reverse Total Shoulder Arthroplasty: What Are Patients Doing?

Background: The indications for reverse total shoulder arthroplasty (RTSA) continue to expand, which has resulted in younger patients who want to remain active after RTSA. Little information is available to manage expectations of both physicians and patients for return to sporting activities.

Purpose: To determine the rate of return to sporting activities and assess average time to return to sports after RTSA.