Racial and Socioeconomic Disparities in Risk and Reason for Revision Total Shoulder Arthroplasty.

Background: With the rise of total shoulder arthroplasty (TSA), revision TSA is also becoming more prominent. However, there is a paucity of literature on potential racial, ethnic and socioeconomic disparities regarding revision TSA. The purpose of this study is to determine the risk and reason for revision TSA between racial, ethnic and socioeconomic groups.

Cirrhosis associated with increased complications and healthcare utilization following total shoulder arthroplasty.

Introduction: Cirrhosis is a known risk factor for morbidity and mortality following surgical procedures and has been associated with increased complications, hospital length of stay (LOS), and cost of admission following total joint arthroplasty. However, a paucity of literature exists evaluating the effect of cirrhosis on postoperative outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term outcomes following elective primary TSA in patients with cirrhosis compared to matched controls.

Racial and ethnic disparities in short-stay primary total shoulder arthroplasty.

Background: There is a paucity of literature evaluating the utilization of short-stay total shoulder arthroplasty (TSA) in different racial groups. The purpose of this study is to compare short-stay TSA utilization and postoperative outcomes across racial groups.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2010 to 2018 to identify patients who underwent primary short-stay TSA, defined as a length of stay of less than 2 midnights.

Frailty is Associated with Increased Complication, Readmission, and Hospitalization Costs Following Primary Total Shoulder Arthroplasty.

Introduction: Frailty is an age-related state of multi-system decline that has been associated with negative outcomes after surgery. Numerous methods have been utilized to quantify frailty and predict postoperative outcomes with variable results. The purpose of this study is to determine if the Hospital Frailty Risk Score (HFRS) is an independent predictor of postoperative complications and increased healthcare costs following elective primary total shoulder arthroplasty (TSA).

Lower Total Shoulder Arthroplasty Cost of Care at an Ambulatory Surgical Center Versus a Main Hospital.

Introduction: Total shoulder arthroplasty (TSA) is an increasingly common orthopaedic procedure. Expansion of TSA to outpatient surgical settings has the potential to reduce costs, although there is limited research on the cost and efficiency of this shift in surgical site of care. The purpose of this study is to compare costs and efficiency of TSA between an ambulatory surgical center (ASC) and a hospital.

Perioperative complications and readmission rates following total shoulder arthroplasty in patients aged 90 and older.

Background: Previous literature has cited age as an independent risk factor for surgical outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to determine the short-term outcomes of nonagenarians following primary TSA and compare them to younger cohorts.

Methods: The Nationwide Readmission Database (NRD) was queried from 2010 to 2020 to identify patients who underwent a primary reverse or anatomic TSA (rTSA or aTSA).

Comparing the Exactech Equinoxe reverse total shoulder arthroplasty for fracture versus degenerative conditions: 5-year minimum follow-up.

Background/hypothesis: Reverse total shoulder arthroplasty (rTSA) has become the operative treatment of choice for acute proximal humerus fractures in the elderly population, but little data exist on the long-term outcomes or how they compare to rTSA done for degenerative conditions. The purpose of this study is to compare the clinical and radiographic outcomes of patients undergoing rTSA for acute fracture versus degenerative conditions with a minimum 5-year follow-up.

Methods: Data was extracted from an international registry of patients with the Exactech Equinoxe rTSA implant from 2007 to 2018.

Medicaid status is independently predictive of increased complications, readmission, and mortality following primary total shoulder arthroplasty.

Background: In recent years, several studies have evaluated the effect of Medicaid insurance status on total shoulder arthroplasty (TSA) outcomes and have presented discordant findings. The purpose of this study is to determine if Medicaid status is an independent predictor of all-cause complications, readmission, revision, and mortality following elective primary TSA using a large, national administrative claims database.

Methods: The Nationwide Readmissions Database was queried to identify patients who underwent elective primary TSA from 2016 to 2020.

Discharge with home health care is associated with increased complications, readmission, and mortality following total shoulder arthroplasty.

Background: Patients undergoing primary anatomic and reverse total shoulder arthroplasty (TSA) are often discharged with home health care (HHC) to provide access to at-home services and facilitate postoperative recovery and continued medical management. The purpose of this study was to evaluate the short-term postoperative outcomes of patients following primary TSA discharged with HHC, including medical and surgical complications, total cost of care, and total hospital length of stay (LOS).

Methods: The Nationwide Readmissions Database was reviewed for patients who underwent elective primary TSA between 2016 and 2020 for a retrospective cohort analysis.

Outcomes following humeral head autograft glenoid reconstruction in primary reverse total shoulder arthroplasty.

Background: Patients with severe glenoid bone loss are at increased risk for poor implant fixation, scapular notching, dislocation, joint kinematic disturbances, and prosthetic failure following reverse total shoulder arthroplasty (rTSA). Glenoid bone grafting has proven useful when performing rTSA in patients with inadequate glenoid bone stock, although the current literature is limited. The purpose of this study is to evaluate clinical outcomes in patients with significant glenoid deformity undergoing primary rTSA with one-stage glenoid reconstruction using a humeral head autograft.

Three-dimensional finite element modeling of glenoid bone loss and baseplate fixation in reverse total shoulder arthroplasty.

Background: Posterior glenoid bone loss is frequently observed in patients with osteoarthritis undergoing reverse total shoulder arthroplasty. Glenoid bone loss can reduce the baseplate back support area and the number of screws for fixation. The purpose of this study is to determine how initial baseplate fixation is affected by biomechanical factors introduced by glenoid bone loss such as reduced baseplate back support area and reduced screw number using three-dimensional finite element analysis.

Delayed elective total shoulder arthroplasty: causes and eventual outcomes.

Purpose: The purpose of this study is to identify risk factors for delays in planned total shoulder arthroplasty (TSA) and determine the perioperative outcomes of TSAs that experienced a delay.

Methods: The American College of Surgeons National Quality Improvement Program (NSQIP) database was queried from 2006 to 2019 for primary TSA. Delayed TSA was defined as surgery that occurred greater than one day after hospital admission.

Pectoralis major tendon transfer in reverse total shoulder arthroplasty with irreparable subscapularis: surgical technique and preliminary clinical and radiological results.

Hypothesis/background: Addressing irreparable subscapularis in conjunction with reverse total shoulder arthroplasty (RTSA) presents challenges. RTSA without subscapularis repair leads to similar clinical results compared to those with a subscapularis repair but with less range of motion in internal rotation (IR). Optimization of IR and anterior stability after RTSA, in the setting of an irreparable subscapularis may be achieved with a pectoralis major (PM) tendon transfer.

Ulnar Collateral Ligament Repair With Internal Brace Using Linked Knotless Suture Anchors.

This article presents an adaptation of the internal brace ulnar collateral ligament (UCL) repair technique using knotless suture anchors, which shows promise for improved postsurgical functionality and a shortened recovery period in patients with UCL injuries. Traditional methods of UCL reconstruction often require a lengthy 12- to 18-month recovery period, presenting a significant challenge for athletes keen to return to their sport. The modified technique uses smaller sutures and drill holes, thereby eliminating the need for larger anchors and simplifying the surgical process.

Predictive factors influencing internal rotation following reverse total shoulder arthroplasty.

Background: Reverse total shoulder arthroplasty (RTSA) is increasingly used as a treatment modality for various pathologies. The purpose of this review is to identify preoperative risk factors associated with loss of internal rotation (IR) after RTSA.

Methods: A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Perioperative complications and outcomes in patients with paraplegia undergoing rotator cuff repair.

Background: Patients with paraplegia often experience chronic shoulder pain due to overuse. We sought to determine if these patients have an increased prevalence of perioperative complications and higher rates of re-admissions and rotator cuff re-tears relative to able-bodied controls following rotator cuff repair (RCR).

Methods: We queried the NRD (2011-2018) to identify all patients undergoing primary RCR (n = 34,451) and identified cohorts of matched paraplegic and non-paraplegic patients (n = 194 each).

Impact of opioid dependence on outcomes following total shoulder arthroplasty.

Introduction: The opioid epidemic is a well-established problem encountered in orthopedic surgery in the United States. Evidence in lower extremity total joint arthroplasty and spine surgery suggests a link between chronic opioid use and increased expense and rates of surgical complications. The purpose of this study was to study the impact of opioid dependence (OD) on the short-term outcomes following primary total shoulder arthroplasty (TSA).

Outcome and complication comparison for intramedullary nail versus open reduction internal fixation in humeral diaphyseal fractures for 2800 matched patient pairs utilizing the Nationwide Readmissions Database.

Introduction: Open reduction internal fixation (ORIF) and intramedullary nail fixation (IMN) are the predominant repair methods for operative treatment of humeral diaphyseal fractures; however, the optimal method is not fully elucidated. The purpose of this study was to analyze whether IMN or ORIF humeral diaphyseal surgeries result in a significantly higher prevalence of adverse outcomes and whether these outcomes were age dependent. We hypothesize there is no difference in reoperation rates and complications between IMN and ORIF for humeral diaphyseal fractures.

Comparison of long-term clinical and radiological outcomes for cemented keel, cemented peg, and hybrid cage glenoids with anatomical total shoulder arthroplasty using the same humeral component.

Aims: The aim of this study was to longitudinally compare the clinical and radiological outcomes of anatomical total shoulder arthroplasty (aTSA) up to long-term follow-up, when using cemented keel, cemented peg, and hybrid cage peg glenoid components and the same humeral system.

Methods: We retrospectively analyzed a multicentre, international clinical database of a single platform shoulder system to compare the short-, mid-, and long-term clinical outcomes associated with three designs of aTSA glenoid components: 294 cemented keel, 527 cemented peg, and 981 hybrid cage glenoids. Outcomes were evaluated at 4,746 postoperative timepoints for 1,802 primary aTSA, with a mean follow-up of 65 months (24 to 217).

How using body mass index cutoffs to determine eligibility for total shoulder arthroplasty affects health care disparities.

Background: The prevalence of obesity in the United States is continuously rising and is associated with increased morbidity, mortality, and health care costs. Body mass index (BMI) has been used as a risk stratification and counseling tool for patients undergoing total joint arthroplasty in an effort to focus on outcome-driven care. Although the use of BMI cutoffs may have benefits in minimizing complications when selecting patients for total shoulder arthroplasty (TSA), it may impact access to care for some patient populations and further increase disparities.

Impact of COVID-19 on clinical outcomes following total shoulder arthroplasty.

Background: The coronavirus (COVID-19) pandemic has introduced patient stressors and changes to perioperative protocols in total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term effects of the COVID-19 pandemic on various patient outcomes and satisfaction following elective TSA.

Methods: A retrospective review was performed on 147 patients who underwent primary TSA at a single institution between June 2019 and December 2020.

Comparison of Efficiency and Effectiveness Between a Slap Hammer and Rigid C-Frame Device for Extraction of an Intramedullary Nail.

Background: Removal of orthopaedic intramedullary implants can be difficult and time-consuming. Instrumentation for implant removal is frequently deficient for effective removal. The purpose of this study was to compare the efficiency of a C-type jig with a standard slap hammer attachment.

Aseptic glenoid baseplate loosening after reverse total shoulder arthroplasty with a single prosthesis.

Background: Early reverse total shoulder arthroplasty (rTSA) designs had high failure rates, mainly from loosening of the glenoid baseplate. The purpose of this study was to determine the incidence of aseptic glenoid baseplate loosening after primary rTSA using a contemporary medialized glenoid-lateralized humerus system and identify significant risk factors associated with loosening.

Methods: A total of 7162 patients underwent primary rTSA with a single-platform rTSA system between April 2007 and August 2021; of these primary rTSA patients, 3127 with a minimum 2-year follow-up period were identified.