Risk factors of instability following reverse total shoulder arthroplasty in patients with no history of shoulder surgery.

Introduction: As its indications expand, reverse total shoulder arthroplasty (rTSA) utilization continues to increase. Though relatively uncommon, instability following rTSA can be associated with significant morbidity and need for subsequent revision and treatment. This case control study aims to characterize factors leading to instability after rTSA, especially in those with no previous shoulder surgery.

Short-term outcomes after primary reverse total shoulder arthroplasty in patients with cervical spine pathology or previous cervical spine surgery compared to those without.

Background: Cervical spine (c-spine) and shoulder pathology have been known to cause similar symptoms and often co-exist, making an accurate diagnosis difficult, especially in an elderly population. Reverse total shoulder arthroplasty (rTSA) has been shown to decrease pain and improve quality of life when shoulder pathology is the source of pain and disability. The purpose of this study was to identify the prevalence of c-spine pathology in a cohort of patients who underwent rTSA and to compare postoperative outcome scores to a cohort without c-spine pathology.

Biomechanical Evaluation of Recurrent Dissociation of Modular Humeral Prostheses.

The purpose of the study was to evaluate the force and torque required to dissociate a humeral head from the unimplanted modular total shoulder replacement system from different manufacturers and to determine if load and torque to dissociation are reduced in the presence of bodily fluids. Impingement, taper contamination, lack of compressive forces, and interference of taper fixation by the proximal humerus have all been reported as possible causes for dissociation. Experimental values determined in this research were compared with literature estimates of dissociation force of the humeral head under various conditions to gain more understanding of the causes of recurrent dissociations of the humeral head.

Opioid requirements in primary versus revision reverse shoulder arthroplasty.

Purpose: The purpose of this study is to evaluate the inpatient pain medication use of patients who had a revision shoulder arthroplasty procedure performed and compare them to a cohort of patients who had a primary reverse total shoulder arthroplasty (rTSA) performed to determine whether revision shoulder arthroplasty requires more pain medication..

Methods: A retrospective review was performed on patients undergoing revision arthroplasty (n = 75) and primary rTSA (n = 340).

Polyethylene Liner Dissociation after Reverse Shoulder Arthroplasty Dislocation: a Case Series.

Reverse shoulder arthroplasty is a common procedure. While dislocation is a common complication, there are few reports documenting dislocation with associated polyethylene liner dissociation from the humeral tray. There have been 4 instances of this occurrence over 9 years at our institution, and there are specific radiographic clues for diagnosis.

Clinical implications of scapular notching at 2 and 5-year follow-up after reverse total shoulder arthroplasty.

Objective: Scapular notching is a unique radiographic sequela of reverse total shoulder arthroplasty (rTSA) with unclear long-term clinical consequences.

Methods: Our retrospective review of a single surgeon, single implant, primary rTSA database investigates the incidence of scapular notching at 2 and 5-year follow-up. Various patient outcome scores were also obtained.

Routine postoperative laboratory tests are unnecessary after primary reverse shoulder arthroplasty.

Background: Obtaining postoperative laboratory studies after primary reverse shoulder arthroplasty (RSA) is a common practice. However, justification of this practice remains unclear. This study assesses the utility of routine postoperative laboratory studies in RSA.

Update on Misrepresentation of Research Publications Among Orthopaedic Surgery Residency Applicants.

Background: Our 2 previous studies (1999, 2007) examining misrepresentation of research publications among orthopaedic residency applicants revealed rates of misrepresentation of 18.0% and 20.6%, respectively.

Conversion to Reverse Total Shoulder Arthroplasty with and without Humeral Stem Retention: The Role of a Convertible-Platform Stem.

Background: Revision shoulder arthroplasty is a technically challenging procedure. It is associated with increased blood loss and operative time, and it frequently necessitates revision implants, augments, and bone-grafting. Shoulder arthroplasty systems with a convertible-platform humeral stem have been developed to reduce the complexity of revision procedures by eliminating the need for humeral component explantation when converting from anatomic shoulder arthroplasty (hemiarthroplasty or total shoulder arthroplasty) to reverse total shoulder arthroplasty (rTSA).

Scapula fracture incidence in reverse total shoulder arthroplasty using screws above or below metaglene central cage: clinical and biomechanical outcomes.

Background: Reverse total shoulder arthroplasty (RTSA) is a viable treatment option for rotator cuff tear arthropathy but carries a complication risk of scapular fracture. We hypothesized that using screws above the central glenoid axis for metaglene fixation creates a stress riser contributing to increased scapula fracture incidence. Clinical type III scapular fracture incidence was determined with screw placement correlation: superior screw vs.

Core decompression and arthroplasty outcomes for atraumatic osteonecrosis of the humeral head.

Background: Humeral head osteonecrosis treatment varies depending on the stage and symptoms. Successful outcomes for humeral head core decompression for stage I/II disease in chronic steroid-induced (CSI) osteonecrosis have been reported, but fewer data exist for sickle cell disease (SCD) etiology. Resurfacing and hemiarthroplasty or total shoulder arthroplasty (TSA) are common for advanced collapse, with mixed results.

Infection Prevention in Shoulder Surgery.

The microbiome of the shoulder demonstrates distinctive differences to other orthopaedic surgical sites. Recent studies have demonstrated that the most common organisms found in deep shoulder infections are coagulase-negative staph lococcal species and Propionibacterium acnes . Many studies support diligent hand washing, decreasing operative time, routine glove changing, minimizing operating room traffic, and covering instruments as means for decreasing the risk of deep infection.

Revision Total Shoulder Arthroplasty without Humeral Component Removal. A Preliminary Report on the Role of a Platform Humeral Component.

Background: Revision total shoulder arthroplasty to a reverse system without removing the humeral component-- i.e., a platform system--has been in use since 2006.

Reverse Shoulder Arthroplasty Augments for Glenoid Wear. Comparison of Posterior Augments to Superior Augments.

Introduction: Patients who are candidates for a reverse total shoulder arthroplasty (rTSA) may have varying amounts and patterns of glenoid wear. The usual treatment of these deformities has been eccentric reaming or bone grafting. Eccentric reaming often removes a large amount of subchondral bone.

Proximal humeral fractures: pin, plate, or replace.

Proximal humeral fractures are becoming increasingly common in individuals older than 60 years, with only fractures of the hip and distal radius occurring with a higher frequency. Most proximal humeral fractures can be managed without surgery; however, if a fracture is displaced or angulated, surgical treatment may be required. There are four main options for the surgical management of proximal humeral fractures: minimally invasive percutaneous reduction and fixation, open reduction and periarticular plating, hemiarthroplasty, and reverse total shoulder arthroplasty.

Impact of inferior glenoid tilt, humeral retroversion, bone grafting, and design parameters on muscle length and deltoid wrapping in reverse shoulder arthroplasty.

Purpose: This study quantifies the ability of humeral retroversion, glenoid tilt, bone graft, and varying prosthesis design parameters to restore anatomic muscle length and deltoid wrapping with reverse shoulder arthroplasty.

Methods: A computer model simulated abduction and internal and external rotation for a normal shoulder, the RSP reverse shoulder, the Equinoxe reverse shoulder, and the Grammont reverse shoulder when implanted using various implantation methods. The length of eight different muscles and the deltoid wrapping angle were quantified to evaluate the ability of each implantation method and design to restore anatomic muscle tensioning.

Evaluation and treatment of the infected shoulder arthroplasty.

Infection after shoulder arthroplasty remains one of the most common postoperative complications. Treatment options range from debridement, appropriate antibiotic regimen, and retaining the implant to resection arthroplasty in the elderly medically challenged patient. We review the diagnostic challenges and treatment options for periprosthetic infections involving the shoulder.

Perspective: Integrating research into surgical residency education: lessons learned from orthopaedic surgery.

Orthopaedic research has advanced tremendously in parallel with accelerated progress in medical science. Possession of a fundamental understanding of basic and clinical science has become more essential than previously for orthopaedic surgeons to be able to translate advances in research into clinical practice. The number of medical graduates with prior education in scientific research who choose to pursue careers in orthopaedic surgery is small.

Scapula fractures after reverse total shoulder arthroplasty: classification and treatment.

Background: Reverse total shoulder arthroplasty (RTSA) implants have been developed to treat patients with deficient rotator cuffs. The nature of this procedure's complications and how these complications should be managed continues to evolve. Fractures of the scapula after RTSA have been described, but the incidence and best methods of treatment are unclear.

Functional and radiographic long-term outcomes of hemiarthroplasty for proximal humeral fractures.

Background: Hemiarthroplasty is the preferred surgical procedure for 3- and 4-part proximal humeral fractures. Our retrospective study examined functional and radiographic outcomes at 2- and 5-year follow-up in patients who received a hemiarthroplasty for 3- and 4-part proximal humeral fractures.

Materials And Methods: Forty-seven consecutive patients of a single surgeon treated with a cemented shoulder hemiarthroplasty between 2000 and 2006 were followed up.

Assuring the research competence of orthopedic graduates.

Objectives: To assure that orthopaedic residents have the knowledge needed to critically appraise the medical/surgical literature and the skills needed to design and conduct musculoskeletal and orthopaedic research.

Setting: Residency program of the Department of Orthopaedic Surgery, Sports Medicine and Rehabilitation at Wright State University Boonshoft School of Medicine, Dayton, Ohio.

Participants: Established in 2005, members of the residency program's Research Team (RT) include orthopaedic faculty and residents, university faculty and graduate students, community scientists, and department staff.

Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer.

Background: We report our experience in treating infected shoulder arthroplasty and primary shoulder sepsis using a commercially produced antibiotic-impregnated cement spacer.

Materials And Methods: We treated 16 shoulders in 15 patients for infected arthroplasty or osteomyelitis of the proximal humerus with irrigation and débridement, hardware removal, or humeral head resection, or both, and placement of an interval articulating hemiarthroplasty with a commercially made gentamicin-impregnated cement spacer.

Results: Mean follow-up was 20.