Baseplate version in reverse shoulder arthroplasty: does excessive retroversion or anteversion affect functional activities of daily living?

Purpose: While bone grafting and augmented components can help restore reverse shoulder arthroplasty (RSA) baseplate version close to neutral, the indication for version correction in RSA is unclear. The purpose of this study was to compare the clinical outcomes of RSA baseplates in high degrees of retroversion and anteversion to components in more neutral version.

Methods: Patients who underwent RSA with minimum two year follow-up were identified from an institutional registry.

Can computer vision / artificial intelligence locate key reference points and make clinically relevant measurements on axillary radiographs?

Purpose: Computer vision and artificial intelligence (AI) offer the opportunity to rapidly and accurately interpret standardized x-rays. We trained and validated a machine learning tool that identified key reference points and determined glenoid retroversion and glenohumeral relationships on axillary radiographs.

Methods: Standardized pre and post arthroplasty axillary radiographs were manually annotated locating six reference points and used to train a computer vision model that could identify these reference points without human guidance.

Anatomic total shoulder arthroplasty for posteriorly eccentric and concentric osteoarthritis: a comparison at a minimum 5-year follow-up.

Background: In patients with glenohumeral osteoarthritis and posteriorly eccentric wear patterns, the early to midterm results of total shoulder arthroplasty (TSA) using conservative glenoid reaming with no attempt at version correction have been favorable at early follow-up. The purpose of this study is to compare the clinical and radiographic outcomes of TSA using this technique for patients with and without eccentric wear patterns at a minimum 5-year follow-up.

Methods: Patients who underwent TSA with minimum 5-year follow-up were identified from an institutional registry.

Operative Management for Displaced Distal Clavicle Fractures.

This article reviews techniques and outcomes of surgical fixation for distal clavicle fractures. Near 100% union has been reported for several techniques. The most common are locked plating, coracoclavicular fixation and a combination of plating with CC fixation.

Massive and Irreparable Rotator Cuff Tears: A Review of Current Definitions and Concepts.

Background: While massive and irreparable rotator cuff tears (MIRCTs) have been abundantly studied, inconsistent definitions in the literature and theories about pain and dysfunction related to them can be difficult to navigate when considering an individual patient.

Purpose: To review the current literature for definitions and critical concepts that drive decision-making for MIRCTs.

Study Design: Narrative review.

Patient satisfaction and clinical outcomes of reverse shoulder arthroplasty: a minimum of 10 years' follow-up.

Background: Reverse shoulder arthroplasty (RSA) has been shown to reliably improve pain and functional outcomes for multiple pathologies. Despite its increasing use in the United States since its introduction in 2004, few studies have investigated long-term outcomes of this procedure. This information is vital in many ways, including durability of functional outcomes, complication profiles, and implant survivorship.

Early Complication Rates Following Total Shoulder Arthroplasty for Instability Arthropathy With a Prior Coracoid Transfer Procedure.

The purpose of this study was to report early complications for anatomic total shoulder arthroplasty (aTSA) performed for instability arthropathy after a prior coracoid transfer procedure and compare them with those of a control group of patients following aTSA for primary osteoarthritis. A retrospective review was performed of 14 patients after aTSA with a prior coracoid transfer procedure. A control group of 42 patients with an aTSA for primary osteoarthritis were matched 3:1 according to age, sex, body mass index, comorbidities, and dominant shoulder.

Novel Use of a Medially Applied Internal Joint Stabilizer for Recurrent Elbow Instability After a Terrible Triad.

Case: A 31-year-old man with recurrent instability after treatment of a terrible triad elbow fracture-dislocation that was reconstructed with revision coronoid fixation and a novel use of a medially applied internal joint stabilizer (IJS).

Conclusion: A medially applied IJS is an option to supplement coronoid fixation in cases with tenuous repair because of comminution or relative coronoid insufficiency. This location may be more protective for this instability pattern and, in revision settings, can avoid a second lateral incision.

Outcomes of anatomic shoulder arthroplasty performed on B2 vs. A1 type glenoids.

Background: Glenoid component malpositioning and glenoid component retroversion have been associated with higher rates of radiolucencies, raising concerns about its implications on glenoid loosening and ultimate failure of anatomic total shoulder arthroplasty (TSA). Although there is literature regarding the relative advantages of techniques to address posterior glenoid bone loss, we are not aware of studies comparing outcomes of TSA on these challenging Walch type B2 glenoids vs. more common A1 glenoids.

A localized laminar flow device decreases airborne particulates during shoulder arthroplasty: a randomized controlled trial.

Background: Although the rate of periprosthetic joint infection following shoulder arthroplasty is low, it is a morbid and costly complication. Airborne particulates have long been recognized as a potential source of wound contamination, and operating room-mounted and smaller localized laminar airflow devices have been developed to minimize airborne particulates. This randomized controlled trial evaluated the effectiveness of a localized laminar flow device in reducing the intrusion of ambient airborne particles and bacteria into the surgery site during shoulder arthroplasty as measured by overall particle counts and colony-forming units (CFUs).

Anatomic and reverse shoulder arthroplasty in patients 70 years of age and older: a comparison cohort at early to midterm follow-up.

Background: Reverse shoulder arthroplasty (RSA) has gained popularity in elderly patients because of its limited reliance on rotator cuff function and high survivorship rates. However, although there are theoretical advantages of RSA over anatomic total shoulder arthroplasty (TSA) in elderly patients, there is little data to guide surgeons on implant selection in this population.

Methods: Patients were identified from our prospectively collected shoulder arthroplasty registry.

Early to midterm outcomes of anatomic shoulder arthroplasty performed on dysplastic glenoids.

Background: Treatment of primary osteoarthritis with glenoid dysplasia or Walch type C glenoids remains controversial. There is scant literature available on patient outcomes after anatomic shoulder arthroplasty in patients with Walch type C glenoids. The purpose of this study was to evaluate the outcomes of total shoulder arthroplasty (TSA) for Walch type C dysplastic glenoids with standard (nonaugmented) glenoid components compared with TSA for glenoids with concentric wear and minimal erosion (Walch type A1).

Risk Factors for Preoperative Opioid Use in Patients Undergoing Primary Anatomic Total Shoulder Arthroplasty.

The effect of preoperative opioid use in orthopedic patients has been highlighted. Numerous studies have identified worse patient outcomes with pre-operative opioid use; however, there is currently no information identifying risk factors for preoperative opioid use in the total shoulder arthroplasty (TSA) population. The purpose of this study was to determine risk factors for preoperative opioid use in patients undergoing primary anatomic TSA for primary osteoarthritis (OA) and to determine baseline preoperative patient-reported outcomes (PROs) in preoperative opioid users compared with nonopioid users.

Outcomes of total shoulder arthroplasty for instability arthropathy with a prior coracoid transfer procedure: a retrospective review and matched cohort.

Background: Many surgeons are concerned about reports of increased complications, worse outcomes, and early failures in patients undergoing anatomic total shoulder arthroplasty after coracoid transfer. The purpose of this study was to evaluate minimum 2-year outcomes following anatomic total shoulder arthroplasty for instability arthropathy with a prior coracoid transfer procedure and compare them with a matched cohort of patients undergoing total shoulder arthroplasty for primary osteoarthritis.

Methods: We identified 11 primary anatomic total shoulder arthroplasties performed by a single surgeon for instability arthropathy with a prior coracoid transfer procedure with a minimum of 2 years' follow-up (mean, 58 ± 35 months).

Lower Socioeconomic Status Is Associated With Worse Preoperative Function, Pain, and Increased Opioid Use in Patients With Primary Glenohumeral Osteoarthritis.

Background: Numerous studies have identified differences in patient-reported outcome scores and complication rates based on various measures of socioeconomic status (SES); however, there is limited information regarding the role of SES in the shoulder arthroplasty cohort. The purpose of this study was to characterize the role of SES in patients undergoing primary anatomic total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis (OA).

Methods: We identified 1,045 patients who had primary TSA done for OA in a prospective shoulder arthroplasty registry, and 982 patients met inclusion criteria.

Revision of failed hemiarthroplasty and anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty.

Background: The impending burden of revision shoulder arthroplasty has increased interest in outcomes of revision procedures. Revision of failed anatomic arthroplasty to reverse total shoulder arthroplasty has shown promise alongside concerning complication rates.

Methods: Patients who underwent revision shoulder arthroplasty during a 7-year period at a tertiary care health system were identified.

Revision of failed hemiarthroplasty for painful glenoid arthrosis to anatomic total shoulder arthroplasty.

Background: The impending burden of revision shoulder arthroplasty has increased interest in outcomes of revision procedures. Painful glenoid arthrosis following hemiarthroplasty is a common cause of reoperation, and conversion to anatomic total shoulder arthroplasty is one option.

Methods: We identified patients who underwent revision of painful hemiarthroplasty to total shoulder arthroplasty over a 15-year period in a single tertiary-care health system.