Outcomes and Costs of Reverse Shoulder Arthroplasty in the Morbidly Obese: A Case Control Study.

Background: The rising number of morbidly obese patients has important consequences for the health-care system. We investigated the effect of morbid obesity on outcomes, complications, discharge disposition, and costs in patients undergoing reverse shoulder arthroplasty.

Methods: Our joint registry was searched for all patients who had undergone primary reverse shoulder arthroplasty for a reason other than fracture from 2003 to 2010 and had a minimum of twenty-four months of follow-up.

Correlation of subjective and objective measures before and after shoulder arthroplasty.

The degree to which subjective patient-reported measures reflects objective findings or how well subjective and objective measures reflect patient satisfaction is not well established. The purpose of this study was to determine the correlation between such measures before and after shoulder arthroplasty. A group of 174 patients (93 total shoulder arthroplasty and 81 reverse shoulder arthroplasty) were prospectively evaluated pre- and postoperatively (mean follow-up, 49 months) with the following subjective measures: American Shoulder and Elbow Surgeons score, Simple Shoulder Test, Short Form 36 (SF-36) summary scores, and patient satisfaction.

Scapular fractures after reverse shoulder arthroplasty: evaluation of risk factors and the reliability of a proposed classification.

Background: The aims were to determine the sensitivity of plain radiographs to detect scapular fractures after reverse shoulder arthroplasty (RSA), to test the reliability of a proposed classification, and to evaluate risk factors.

Materials And Methods: We matched 53 patients with scapular fractures after RSA to 212 control patients. Clinical risk factors were assessed by correlating comorbidities.

Preparing for the bundled-payment initiative: the cost and clinical outcomes of reverse shoulder arthroplasty for the surgical treatment of advanced rotator cuff deficiency at an average 4-year follow-up.

Background: The purpose of this study is to report on cost, outcomes, reliability, and safety of reverse shoulder arthroplasty (RSA) in patients with symptomatic advanced rotator cuff deficiency.

Methods: Fifty-five primary RSA patients operated on at a single institution by a single surgeon were prospectively studied for a mean of 48 months (range, 31-71 months). For each patient, validated subjective and independently evaluated objective outcome data were collected to determine clinical reliability.

Preparing for the bundled-payment initiative: the cost and clinical outcomes of total shoulder arthroplasty for the surgical treatment of glenohumeral arthritis at an average 4-year follow-up.

Background: The purpose of this study is to report on cost, outcomes, reliability, and safety of total shoulder arthroplasty (TSA) in patients with symptomatic glenohumeral joint arthritis.

Materials And Methods: Eighty-three primary TSA patients operated on at a single institution by a single surgeon were prospectively studied for a mean of 48 months (range, 32-69 months). For each patient, validated subjective and independently evaluated objective outcome measures were collected to determine clinical reliability of TSA.

Isometric strength, range of motion, and impairment before and after total and reverse shoulder arthroplasty.

Background: Medicare Part A provides similar resources for coverage of inpatient hospitalization costs for patients treated with total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). This is based on an assumption that TSA and RSA are used to treat similar patient populations with comparable disease severity. However, no objective clinical information is available to support this resource allocation.

Obesity, leukocytosis, embolization, and injury severity increase the risk for deep postoperative wound infection after pelvic and acetabular surgery.

Objective: To determine if preoperative fever and leukocytosis without an established source of untreated infection are independent risk factors for the development of deep postoperative wound infection (DPWI) after surgical treatment of pelvic and acetabular fractures.

Design: Retrospective chart and radiographic review; matched case-control comparison.

Setting: : Level 1 regional referral trauma center.

Cost analysis in shoulder arthroplasty surgery.

Cost in shoulder surgery has taken on a new focus with passage of the Patient Protection and Affordable Care Act. As part of this law, there is a provision for Accountable Care Organizations (ACOs) and the bundled payment initiative. In this model, one entity would receive a single payment for an episode of care and distribute funds to all other parties involved.

Reverse shoulder arthroplasty components and surgical techniques that restore glenohumeral motion.

Background: Modifications in reverse shoulder arthroplasty (RSA) have been made with the intent of maximizing motion, although there is little objective evidence outlining their benefit. This study investigated the RSA component combinations that impart the greatest effect on impingement-free glenohumeral motion.

Methods: A previously validated virtual shoulder model was implanted with RSA components that varied by humeral implant type (inset/onset), glenosphere diameter (30, 36, and 42 mm), glenosphere placement (inferior/neutral), glenosphere center-of-rotation offset (0, 5, and 10 mm), humeral neck-shaft angle (130° and 150°), and humeral offset (zero, five, and ten mm).

Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws.

Background: The purpose of this study is to retrospectively evaluate the clinical outcomes of 18 patients with large coronal shear fractures of the capitellum and lateral trochlea that underwent open reduction and internal fixation with headless compression screws.

Methods: Eighteen patients were identified (16 women, 2 men) with an average age of 45 years and an average follow-up of 26 months. Fractures were classified according to the Dubberley classification as 11 type-1A injuries and 7 type-2A injuries.

Revision arthroplasty with use of a reverse shoulder prosthesis-allograft composite.

Background: Patients with disabling pain and loss of shoulder function with associated proximal humeral bone loss following shoulder arthroplasty have limited reliable treatment options. Our objective was to report the results, obtained as part of a prospective outcomes study, of the use of a reverse shoulder prosthesis-allograft composite in these patients.

Methods: Between 2002 and 2005, 353 patients treated with a reverse shoulder prosthesis were enrolled in a prospective cohort study.

Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency.

Background: Early designs of reverse shoulder arthroplasty components for the treatment of glenohumeral arthritis associated with severe rotator cuff deficiency in some cases have been associated with mechanical failure. The purpose of this study was to perform a prospective outcomes study of reverse shoulder arthroplasty performed with use of 5.0-mm peripheral locking screws for baseplate fixation and a lateralized center of rotation for the treatment of a rotator cuff deficiency.

Young patients with shoulder chondrolysis following arthroscopic shoulder surgery treated with total shoulder arthroplasty.

Chondrolysis following shoulder arthroscopy is a devastating complication, often seen in young patients. After nonoperative measures have been exhausted, there are few treatment options available that reliably improve pain and function. The purpose of this study is to examine the intra-operative findings, radiographic features, and clinical outcomes of a series of patients with chondrolysis following arthroscopic surgery managed with a total shoulder arthroplasty.

In vitro and finite element analysis of glenoid bone/baseplate interaction in the reverse shoulder design.

We developed biomechanical and finite element models, using high-strength polyurethane foam blocks, to represent the glenoid bone/baseplate junction to determine if increasing the distance between the glenoid bone and the center of rotation of the glenosphere increases baseplate motion during static loading in the reverse shoulder design. Although there was a general trend toward increased baseplate motion with increasing distance from the glenoid to the center of rotation, in vitro mechanical testing revealed no significant difference between the 7 glenosphere types tested, with average baseplate motion during 1000 load cycles ranging from 90 mum to 120 mum. Results from the finite element analysis strongly correlated with the in vitro mechanical testing.