Publications by authors named "Lawrence V Gulotta"
Purpose: To determine the scope and accuracy of medical information provided by ChatGPT-4 in response to clinical queries concerning total shoulder arthroplasty (TSA), and to compare these results to those of the Google search engine.
Methods: A patient-replicated query for 'total shoulder replacement' was performed using both Google Web Search (the most frequently used search engine worldwide) and ChatGPT-4. The top 10 frequently asked questions (FAQs), answers, and associated sources were extracted.
Article Synopsis
- * A total of 2.1% of patients (n=138) experienced dislocations, primarily within the first 90 days post-surgery, with different treatment approaches for dislocation including closed reduction, open reduction, revision arthroplasty, or benign neglect.
- * Among those treated with closed reduction, only 31% were successfully resolved without further intervention, while many either required revision surgery or experienced recurrent dislocations, highlighting the complexity of managing these postoperative complications.
Article Synopsis
- Three patients with cysts in their acromioclavicular joints, caused by rotator cuff problems, were treated with a specific surgical technique.
- The procedure involved arthroscopic cyst decompression and removing part of the clavicle, which successfully eliminated the cysts with low chances of them coming back.
- The study suggests that this surgical approach is a better option than repeatedly draining the cysts or performing traditional open surgery.
Article Synopsis
- Glenoid version is an important measurement for shoulder arthroplasty, but the methods of measuring it vary widely across different studies due to advancements in imaging technology.
- A systematic literature search identified 61 studies involving over 17,000 shoulder arthroplasties, with less than half specifying their measurement techniques for glenoid version.
- The majority of studies relied on CT scans (63.9%) for preoperative measurements, and there has been an increasing trend in the use of 3D CT over the years (from 12.5% in 2012-2014 to 52% in 2021-2023).
Article Synopsis
- * Studies show that this technology leads to better precision in screw placement and fewer screws used, resulting in improved patient outcomes and fewer complications.
- * Further research is needed to confirm its benefits and assess the cost-effectiveness, while new technologies like augmented reality and robotic surgery may enhance shoulder arthroplasty even further.
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.
Aims: Proximal humeral fractures are the third most common fracture among the elderly. Complications associated with fixation include screw perforation, varus collapse, and avascular necrosis of the humeral head. To address these challenges, various augmentation techniques to increase medial column support have been developed.
View Article and Find Full Text PDFPurpose: To assess the ability of ChatGPT-4, an automated Chatbot powered by artificial intelligence, to answer common patient questions concerning the Latarjet procedure for patients with anterior shoulder instability and compare this performance with Google Search Engine.
Methods: Using previously validated methods, a Google search was first performed using the query "Latarjet." Subsequently, the top 10 frequently asked questions (FAQs) and associated sources were extracted.
Article Synopsis
- Improper sequencing of maximal joint and segment velocities is a key factor in predicting throwing arm performance and ball velocity in pitchers.
- This study analyzed 59 high school and 338 professional pitchers to assess variations in segment velocities during fastball pitches using 3D motion capture.
- Results showed that both HS and PRO pitchers with low variance in specific segment velocities exhibited significantly lower maximal joint velocities and forces compared to their respective populations.
Article Synopsis
- The study aimed to assess early complications and the need for revision surgery in young patients after primary medial ulnar collateral ligament (MUCL) repair, with at least 2 years of follow-up.
- A total of 313 patients were reviewed, finding a 7.3% early complication rate, mainly due to ulnar neuropathy, and a low revision surgery rate of 1.0%.
- The majority of patients with postoperative ulnar neuropathy had undergone ulnar nerve procedures during the primary surgery, with most complications occurring within the first six months post-op.
Background: Patients who undergo total shoulder arthroplasty usually have excellent long-term outcomes. However, a subset of patients is diagnosed with a prosthetic joint infection (PJI) requiring revision procedures and prolonged recovery. The purpose of this study was to evaluate rates of recurrent shoulder PJI in patients undergoing débridement, antibiotics, and implant retention (DAIR), single-stage revision, and 2-stage revision.
View Article and Find Full Text PDFAims: The primary aim of this prospective, multicentre study is to describe the rates of returning to golf following hip, knee, ankle, and shoulder arthroplasty in an active golfing population. Secondary aims will include determining the timing of return to golf, changes in ability, handicap, and mobility, and assessing joint-specific and health-related outcomes following surgery.
Methods: This is a multicentre, prospective, longitudinal study between the Hospital for Special Surgery, (New York City, New York, USA) and Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, (Edinburgh, UK).
Predictors of dislocations after reverse shoulder arthroplasty: a study by the ASES complications of RSA multicenter research group.
J Shoulder Elbow Surg
January 2024
Article Synopsis
- Instability or dislocation after reverse shoulder arthroplasty (RSA) is a common problem that doctors face when treating patients.
- A big study involving over 6,600 patients from 15 different hospitals looked at how often dislocations happen and what factors might cause them.
- The results showed that the overall dislocation rate was 2.1%, but higher for patients getting revision surgeries, and some patients were more likely to dislocate than others based on their specific shoulder issues.
Article Synopsis
- The study investigates the risk factors for acromial and scapular spine fractures following reverse shoulder arthroplasty in patients with different diagnoses such as glenohumeral arthritis, rotator cuff arthropathy, and massive irreparable rotator cuff tears.
- Data from 4,764 patients who underwent the procedure between January 2013 and June 2019 were analyzed, revealing an overall stress fracture incidence of 4.1%, with higher rates in patients with rotator cuff issues compared to those with arthritis.
- Specifically, the presence of inflammatory arthritis was a significant predictor of fractures in glenohumeral arthritis patients, while factors such as sex and osteoporosis were also relevant in the rotator cuff arthropathy
Background: Accurate and rapid identification of implant manufacturer and model is critical in the evaluation and management of patients requiring revision total shoulder arthroplasty (TSA). Failure to correctly identify implant designs in these circumstances may lead to delay in care, unexpected intraoperative challenges, increased morbidity, and excess health care costs. Deep learning (DL) permits automated image processing and holds the potential to mitigate such challenges while improving the value of care rendered.
View Article and Find Full Text PDFBackground: It has previously been speculated that baseball pitchers who display excessive forearm pronation at foot contact (FC) have a higher propensity toward ulnar collateral ligament injury and subsequent surgery.
Purpose: To evaluate the association between degree of forearm pronation/supination at FC and throwing arm kinetics in high school and professional pitchers, at both the individual (intrapitcher) and the group (interpitcher) level.
Study Design: Descriptive laboratory study.
Survival analyses and their applications in orthopaedics.
Knee Surg Sports Traumatol Arthrosc
June 2023
Survival analyses are a powerful statistical tool used to analyse data when the outcome of interest involves the time until an event. There is an array of models fit for this goal; however, there are subtle differences in assumptions, as well as a number of pitfalls, that can lead to biased results if researchers are unaware of the subtleties. As larger amounts of data become available, and more survival analyses are published every year, it is important that healthcare professionals understand how to evaluate these models and apply them into their practice.
View Article and Find Full Text PDFArticle Synopsis
- - The study reviews the effectiveness of subacromial balloon spacers as a treatment for patients with massive, irreparable rotator cuff tears, aiming to determine if this procedure leads to meaningful clinical improvements.
- - Researchers analyzed 10 studies and found that 83% of patients achieved significant improvement in shoulder function using the Constant-Murley score, indicating the procedure is beneficial.
- - Results show high rates of clinically significant outcomes, such as 98% of patients achieving the minimum acceptable symptom state and varying success rates in another assessment measure known as the ASES score over follow-up periods.
Background: Biodegradable subacromial balloon spacers (SBSs) have become increasingly used for the treatment of massive irreparable rotator cuff tears given their theorized clinical benefits; however, the relationship between biomechanical functions of the balloon spacer and clinical benefits remains unclear.
Purpose: To perform a systematic review and meta-analysis of controlled laboratory studies investigating the use of SBSs for massive irreparable rotator cuff tears.
Study Design: Systematic review and meta-analysis; Level of evidence, 4.
Background: Recent advances in implant technology have allowed for modular or platform humeral stem insertion during initial anatomic total shoulder arthroplasty (TSA). These systems allow for humeral stem retention during conversion to reverse TSA (RTSA). However, some patients still require humeral stem revision when undergoing revision to RTSA.
View Article and Find Full Text PDFBackground: The concordance between preoperative synovial fluid cultures and intraoperative tissue cultures for identifying pathogenic microorganisms in shoulder periprosthetic joint infection (PJI) remains poorly understood. The purpose of our study was to examine the diagnostic accuracy of positive synovial fluid culture results in early pathogen identification for shoulder PJI.
Methods: A total of 35 patients who met the Musculoskeletal Infection Society criteria for PJI following primary anatomic or reverse arthroplasty and the study inclusion criteria were identified retrospectively from a single institution (multiple surgeons) from January 2011 to June 2021.
Limited English language proficiency in patients undergoing total shoulder arthroplasty (TSA) may make treatment more challenging. : We sought to investigate the potential association between TSA patients' use of a language interpreter and 2 outcomes: hospital length of stay (LOS) and discharge disposition. : We conducted a retrospective cohort study comparing LOS and discharge disposition after TSA for patients who required interpreter services and patients who did not at a single institution in an urban setting between 2016 and 2020.
View Article and Find Full Text PDFThere is increasing interest in reverse total shoulder arthroplasty (RTSA) as a reliable treatment for arthritic, rotator cuff deficient shoulders. Humeral and glenoid version are controversial parameters that can influence internal and external rotation, muscular forces, and implant stability as outcomes of RTSA. The aim of this study was to obtain an overview of the current knowledge on the effect of both humeral component version and glenoid component version and give recommendations on their most optimal degree for RTSA.
View Article and Find Full Text PDFBackground: Nerve injury following reverse shoulder arthroplasty (RSA) is a known risk factor with wide ranging incidences reported. This systematic review evaluates the overall incidence of nerve injury following primary and revision RSA and summarizes the characteristics of the nerve injuries reported in the current literature.
Methods: A systematic review was performed using separate database searches (Pubmed, Embase, Web of Science, Cochrane) following the PRISMA guidelines.