The Effect of Lateralization on Clinical Outcomes after Anatomic Total Shoulder Arthroplasty.

Background: Lateralization has been previously studied for reverse shoulder arthroplasty, but there is little clinical research investigating the independent effect of medialization or lateralization of the joint line, nor global medialization or lateralization for anatomic total shoulder arthroplasty (TSA). The goal of this study was to assess the impact of lateralization on clinical outcomes after anatomic TSA.

Methods: A retrospective review of a multi-institutional registry was performed.

Does lateralizing the glenosphere center of rotation by 4 mm decrease scapular notching in reverse shoulder arthroplasty with a 135° humeral component?

Background: Scapular notching continues to be associated with reverse shoulder arthroplasty (RSA) and is thought to lead to fewer outcomes. Decreasing the humeral neck-shaft angle (NSA) has been associated with decreased incidence of scapular notching. Lateralizing the glenosphere center of rotation (COR) has also been proposed to decrease notching; however, its effect in lower NSA RSA is less understood.

Suture cerclage for stabilizing the humeral shaft during shoulder arthroplasty.

Background: In shoulder arthroplasty, cerclage fixation techniques are used to stabilize osteotomies, fractures, and allografts. Fixation techniques including cerclage with metal and polymer cables have been described. The purpose of this study was to evaluate suture cerclage fixation of the humeral shaft during shoulder arthroplasty.

Radiographic changes and clinical outcomes associated with an adjustable diaphyseal press-fit humeral stem in primary reverse shoulder arthroplasty.

Background: Press-fit humeral fixation in reverse shoulder arthroplasty (RSA) has become increasingly popular; however, radiographic analysis of these stems is limited. We aimed to evaluate the radiographic and clinical outcomes of an adjustable diaphyseal press-fit humeral stem in primary RSA.

Methods: We conducted a retrospective review of 232 primary RSAs in 219 patients performed by a single surgeon using this system.

Simple Moving Average: A Method of Reporting Evolving Complication Rates.

Surgeons often cite published complication rates when discussing surgery with patients. However, these rates may not truly represent current results or an individual surgeon's experience with a given procedure. This study proposes a novel method to more accurately report current complication trends that may better represent the patient's potential experience: simple moving average.

Radiographic evaluation of short-stem press-fit total shoulder arthroplasty: short-term follow-up.

Background: Humeral loosening is an uncommon etiology for revision shoulder arthroplasty. We aimed to evaluate the radiographic and clinical outcomes of a short-stem press-fit humeral component after primary total shoulder arthroplasty.

Methods: We reviewed our patient database, from January 2008 to December 2011, for primary total shoulder arthroplasties performed with a short-stem press-fit humeral component.

Analysis of severely fractured glenoid components: clinical consequences of biomechanics, design, and materials selection on implant performance.

Background: The longevity of total shoulder replacement is primarily limited by the performance of the ultrahigh-molecular-weight polyethylene (UHMWPE) glenoid component in vivo. Variations in glenoid design (conformity, thickness), biomechanics (joint kinematics), and UHMWPE material selection (sterilization, cross-linking) distinguish total shoulder replacements from hip and knee arthroplasty devices. These variables can lead to severe mechanical failures, including gross fracture.

Radiographic and clinical outcomes of total shoulder arthroplasty with an all-polyethylene pegged bone ingrowth glenoid component: prospective short- to medium-term follow-up.

Background: Glenoid components often cause total shoulder arthroplasty failure. This study examines short-term to midterm radiographic and clinical results of a hybrid glenoid component with 3 cemented peripheral pegs and a central peg, which allows biologic fixation with use of native humeral head autograft.

Methods: In 4 years, 80 glenoid components were implanted during primary total shoulder arthroplasty with at least 2-year follow-up data.

Have levels of evidence improved the quality of orthopaedic research?

Background: Since 2003 many orthopaedic journals have adopted grading systems for levels of evidence (LOE). It is unclear if the quality of orthopaedic literature has changed since LOE was introduced.

Questions/purposes: We asked three questions: (1) Have the overall number and proportion of Level I and II studies increased in the orthopaedic literature since the introduction of LOE? (2) Is a similar pattern seen in individual orthopaedic subspecialty journals? (3) What is the interobserver reliability of grading LOE?

Methods: We assigned LOE to therapeutic studies published in 2000, 2005, and 2010 in eight major orthopaedic subspecialty journals.

Amphotericin B is cytotoxic at locally delivered concentrations.

Background: Orthopaedic fungal infections are commonly treated with systemic amphotericin, which has a narrow therapeutic index and is associated with systemic toxicities. Local delivery of amphotericin has been described yet is poorly understood. As with bacterial infections, fungal infections are associated with biofilm.