Biomechanical characteristics of subscapularis-sparing approach for anatomic total shoulder arthroplasty.

Background: A technique for retaining the superior 50% of the subscapularis insertion for anatomic total shoulder arthroplasty has been described. This cadaveric study biomechanically evaluates this subscapularis-sparing approach and compares it with a complete subscapularis release and repair technique to determine whether there is a higher load to failure.

Materials And Methods: Twelve matched pairs of human cadaveric arms were distributed into 3 test groups.

Payor Reform Opportunities for Spine Surgery: Part II: The Potential Emergence of Population Health.

The pressures on spine surgery to adopt value-based reimbursement models are being seen in the increased implementation of bundled payment strategies. Given that bundled payment models typically link payments to the initiation of the surgical episode in question, despite their potential cost-saving attributes, financial incentives remain tied to the volume of services being provided. As payors and policy makers look to find savings by focusing on waste and variation of care, more comprehensive models such population health strategies are now being develop and deployed.

Payor Reform Opportunities for Spine Surgery: Part III: Population Health Programs and Converging Strategies.

As the cost of health care continues to rise, government and commercial payors are implementing strategies as a means of reducing the overall expenditure of health care dollars. The largest savings will be not just in more cost-effective treatments but in strategies that can avoid the need for treatments in the first place. Although the savings from popular payor reform strategies like bundled payments are tied to the initiation of the clinical episode, population health programs utilize a variety of tactics to decrease the need for health care utilization overall.

Payor Reform Opportunities for Spine Surgery: Part I: Background and Stimulus for Bundled Payments.

Spine surgery, and orthopedic surgery overall, is being increasingly scrutinized by payors due to large projected increases in utilization. The unsustainability of the fee-for-service payment system has lead payors to investigate novel value and risk-based contracting strategies on an episode of care basis and on a population health basis. These forays into progressive models for spine surgery have been supported by the successes demonstrated by advanced payor reform programs from The Centers for Medicare and Medicaid Services in other areas of musculoskeletal medicine.

Evolving Beyond Craft Surgery Is Both Inevitable and Essential.

Given the increasing emphasis in health care on improving outcomes, reproducible results, and creating value for the patient, orthopedic surgery in particular must necessarily continue to progress away from an individualized and a surgeon-specific technical craft and toward a highly automated and computer-integrated process in which surgeon and digitized systems interact to provide the most reproducible and consistent outcomes possible. In doing so, orthopedic surgery would follow the same path that every other highly reliable and safety conscious industry has adopted by absolute necessity. This evolution should therefore not be discouraged but rather embraced and accelerated.

Assessment of rotator cuff repair integrity using ultrasound and magnetic resonance imaging in a multicenter study.

Background: This study compared ultrasound and magnetic resonance imaging (MRI) evaluation of the repaired rotator cuff to determine concordance between these imaging studies.

Methods: We performed a concordance study using the data from a prospective nonrandomized multicenter study at 13 centers. A suture bridge technique was used to repair 113 rotator cuff tears that were between 1 and 4 cm wide.

Clinical, radiographic, and ultrasonographic comparison of subscapularis tenotomy and lesser tuberosity osteotomy for total shoulder arthroplasty.

Background: Recently, a lesser tuberosity osteotomy has been promoted as an alternative to tenotomy for release of the subscapularis during shoulder arthroplasty. To our knowledge, no direct comparison of the clinical results of the two techniques has been presented.

Methods: Thirty-five shoulders in thirty-four consecutive patients with osteoarthritis who had a primary total shoulder arthroplasty, performed with use of a standard subscapularis tenotomy (Group 1) or lesser tuberosity osteotomy (Group 2) to release the subscapularis, were evaluated retrospectively at an average of thirty-three months.

Three-dimensional volume-rendering computed tomography for measuring humeral version.

Hypothesis: Humeral version is highly variable in human beings. Accurate assessment of humeral version may allow for more anatomic reconstruction at shoulder arthroplasty. Two-dimensional (2D) computed tomography (CT) has been used to measure humeral version but has limitations of poor interobserver reproducibility and strict dependence on arm positioning during image acquisition.

Glenohumeral arthrodesis after failed prosthetic shoulder arthroplasty. Surgical technique.

Background: While there have been numerous reports concerning glenohumeral arthrodesis for many indications, there is little available information specific to glenohumeral arthrodesis performed after failed prosthetic shoulder arthroplasty. The purpose of this study was to report the outcomes of glenohumeral arthrodesis in the setting of severe glenohumeral bone loss and deltoid muscle and rotator cuff insufficiency following failed prosthetic shoulder arthroplasty.

Methods: We retrospectively reviewed clinical and radiographic data on seven consecutive patients treated with glenohumeral arthrodesis following a failed prosthetic shoulder arthroplasty between 1997 and 2004.

The influence of three-dimensional computed tomography images of the shoulder in preoperative planning for total shoulder arthroplasty.

Background: Arthritic changes to glenoid morphology can be difficult to fully characterize on both plain radiographs and conventional two-dimensional computer tomography images. We tested the hypothesis that three-dimensional imaging of the shoulder would increase inter-rater agreement for assessing the extent and location of glenoid bone loss and also would improve surgical planning for total shoulder arthroplasty.

Methods: Four shoulder surgeons independently and retrospectively reviewed the preoperative computed tomography scans of twenty-four arthritic shoulders.

Inter-rater reliability of an arthritic glenoid morphology classification system.

To our knowledge, no independent analysis of the inter-rater agreement of the widely used Walch classification for osteoarthritic glenoid morphology has been performed. The computed tomography scans of 24 shoulders with primary osteoarthritis were used by 4 experienced shoulder surgeons to classify the glenoids independently according to Walch et al. The weighted kappa statistic was calculated to determine the inter-rater and intrarater agreement among observers.

The three-dimensional glenoid vault model can estimate normal glenoid version in osteoarthritis.

Glenohumeral arthroplasty can involve correcting pathologic glenoid tilt or version. Predicting the physiologic glenoid version for a particular individual can be difficult. We propose using a previously validated, 3-dimensional, glenoid vault model as a template to predict normal glenoid version.

Quantitative analysis of glenoid bone loss in osteoarthritis using three-dimensional computed tomography scans.

The 3-dimensional (3D) shape of the glenoid vault has been defined previously and shown to be a complex, yet consistent, shape in individuals without glenoid pathology. We proposed assessing whether this conserved shape could be used as a template to measure glenoid bone loss in subjects with glenohumeral osteoarthritis. Computed tomography (CT) scans of both shoulders were obtained from 12 subjects with unilateral glenohumeral osteoarthritis.

Bone grafting severe glenoid defects in revision shoulder arthroplasty.

Unlabelled: During revision total shoulder arthroplasty, bone grafting severe glenoid defects without concomitant reinsertion of a glenoid prosthesis may be the only viable reconstructive option. However, the fate of these grafts is unknown. We questioned the durability and subsidence of the graft and the associated clinical outcomes in patients who have this procedure.

Glenohumeral arthrodesis after failed prosthetic shoulder arthroplasty.

Background: While there have been numerous reports concerning glenohumeral arthrodesis for many indications, there is little available information specific to glenohumeral arthrodesis performed after failed prosthetic shoulder arthroplasty. The purpose of this study was to report the outcomes of glenohumeral arthrodesis in the setting of severe glenohumeral bone loss and deltoid muscle and rotator cuff insufficiency following failed prosthetic shoulder arthroplasty.

Methods: We retrospectively reviewed clinical and radiographic data on seven consecutive patients treated with glenohumeral arthrodesis following a failed prosthetic shoulder arthroplasty between 1997 and 2004.

Intraarticular distal humerus fracture complicated by osteogenesis imperfecta treated with primary total elbow arthroplasty: a case report.

Intraarticular fractures of the distal humerus are challenging problems for the treating surgeon. When these fractures are complicated by severe comminution and poor bone quality, open reduction and internal fixation may lead to poor clinical outcomes when compared with those treated with primary total elbow arthroplasty. The population in which this clinical scenario most often arises is the elderly.

Retrograde femoral nailing complicated by spurious fracture of the femoral neck.

The presence of a fracture of the femoral neck and ipsilateral diaphyseal femur fracture has been reported previously. In all femoral shaft fractures, scrutiny of the femoral neck is mandatory in order to direct proper management toward this potentially devastating complication. This report discusses a case of an intraoperative radiographic artifact secondary to retrograde nailing of a femoral shaft fracture which may be interpreted as an occult or iatrogenic ipsilateral fracture of the femoral neck.

Biomechanical comparison of posterior pelvic ring fixation.

Objective: To determine relative stiffness of various methods of posterior pelvic ring internal fixation.

Design: Simulated single leg stance loading of OTA 61-Cl.2, a2 fracture model (unilateral sacroiliac joint disruption and pubic symphysis diastasis).