Regional variation from 2013 to 2021 in primary total shoulder arthroplasty utilization, reimbursement, and patient populations.

Background: Total shoulder arthroplasty (TSA), encompassing both anatomical and reverse TSA, has increased in popularity worldwide. The purpose of this study was to assess how TSA utilization, reimbursement, surgeon practices, and patient populations have evolved within the Medicare population from 2013 to 2021 at a national and regional level.

Methods: The Medicare Physician and Other Practitioners dataset was queried for all episodes of primary TSA (CPT-23472), both anatomic and reverse, between years 2013 and 2021.

Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty.

Background: Intraoperative complications after shoulder arthroplasty (SA) are uncommon, yet surgeons continue to obtain immediate postoperative radiographs despite prior literature questioning the efficacy of these images. There is a paucity of literature describing the role of immediate postoperative radiographs in revision SA. This study aimed to evaluate the utility of immediate postoperative radiographs in identifying intraoperative complications leading to a change in care after primary or revision SA.

Liposomal bupivacaine interscalene nerve block in shoulder arthroplasty is not superior to plain bupivacaine: a double-blinded prospective randomized control trial.

Background: Interscalene brachial plexus blocks are a common modality used to provide adjunctive pain relief with shoulder replacement surgery. In 2018, the Federal Drug Administration approved the use of liposomal bupivacaine (LB) for such nerve blocks. We sought to evaluate whether this formulation of bupivacaine would provide superior pain relief for shoulder replacement patients over standard bupivacaine alone.

Calcific Tendonitis of the Shoulder: Protector or Predictor of Cuff Pathology? A Magnetic Resonance Imaging-Based Study.

Purpose: The purpose of this investigation is to assess the incidence of rotator cuff tears in cases of calcific tendonitis and evaluate for differences in the incidences of rotator cuff tears by magnetic resonance imaging (MRI) between calcific lesions of different morphology, size, or location.

Methods: This single-center study involved a retrospective chart review searching for patients from January 2010 to April 2017 with a diagnosis of calcific tendonitis of the shoulder based on review of all MRI reads done on patients with shoulder pain. Anteroposterior radiographic and MRI studies were reviewed by a musculoskeletal radiologist to assess calcific tendonitis morphology, size, distance from cuff insertion, and any rotator cuff tear.

Analysis of 90-Day Readmissions After Total Shoulder Arthroplasty.

Background: The number of total shoulder arthroplasty (TSA) procedures performed annually is increasing as a result of an aging population and an increased access to subspecialty-trained upper extremity arthroplasty surgeons. An up-to-date analysis of the incidence of, risk factors for, and reasons for 90-day readmissions in primary anatomic TSA has yet to be performed.

Purpose: To characterize 90-day readmissions on a national level.

Clinical Efficacy of Liposomal Bupivacaine: A Systematic Review of Prospective, Randomized Controlled Trials in Orthopaedic Surgery.

Background: There has been a surge in interest with regard to the utility of liposomal bupivacaine as part of a perioperative pain management protocol. The current study was proposed to critically assess the efficacy of liposomal bupivacaine as a local anesthetic for pain relief following orthopaedic procedures.

Methods: A systematic review of prospective, randomized trials involving liposomal bupivacaine was performed using searches of the PubMed, Embase, and Cochrane databases.

Ninety-day readmissions following reverse total shoulder arthroplasty.

Background: An adequate characterization of 90-day readmissions after primary reverse total shoulder arthroplasty (RTSA) on a national level remains to be undertaken. As bundled payment models become more prevalent, an improved understanding of readmission data will help to predict resource utilization and expenses.

Methods: All adult patients who underwent elective primary RTSA in 2014 in the National Readmission Database were included in the analysis.

Compressive osseointegration endoprosthesis for massive bone loss in the upper extremity: surgical technique.

Background: Reconstruction of large segments of bone loss can be very difficult. The use of a prestressed ingrowth implant can offer an attractive surgical option in these challenging cases.

Methods: This report describes the surgical technique in depth, combining the experience of the authors.

Polyethylene dissociation from humeral stem status after reverse total shoulder arthroplasty.

Background: Reverse shoulder arthroplasty (RSA) is an important treatment option for 4-part proximal humerus fractures in the elderly and arthrosis of the glenohumeral joint with incompetence of the rotator cuff. Unique complications do occur with use of this type of prosthesis.

Methods: We present 4 cases of polyethylene dissociation after RSA.

Use of Compressive Osseointegration Endoprostheses for Massive Bone Loss From Tumor and Failed Arthroplasty: A Viable Option in the Upper Extremity.

Background: Endoprostheses using principles of compressive osseointegration have shown good survivorship in several studies involving the lower extremity; however, no series to our knowledge have documented the use of this technology in the management of massive bone loss in the upper limb.

Questions/purposes: (1) What proportion of upper extremity implants using compressive osseointegration fixation principles achieved durable short-term fixation, and what were the modes of failure? (2) What surgical complications resulted from reconstruction using this technique?

Methods: A multiinstitutional retrospective review identified nine patients (five women; four men) who underwent 13 endoprosthetic replacements between 2003 and 2014 using compressive osseointegration (Compliant Pre-stress Device [CPS]; Biomet Inc, Warsaw, IN, USA) in the upper extremity, including two proximal humeri, two humeral diaphyses, seven distal humeri, and two proximal ulna. During the early part of that period, the indication for use of a compressive prosthesis in our centers was revision of a previous tumor reconstruction (allograft-prosthetic composite or stemmed endoprosthetic reconstruction) (three patients; five implants), or revision arthroplasty with massive bone loss (three patients, four implants); more recently, indications became somewhat more permissive and included posttraumatic bone loss (one patient, one implant), primary bone sarcoma, and resections with very short remaining end segments after diaphyseal resections (two patients, three implants).

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.

Tranexamic acid decreases blood loss in total shoulder arthroplasty and reverse total shoulder arthroplasty.

Background: Efficacy of tranexamic acid (TXA) remains unproven in the setting of shoulder arthroplasty. The purpose of this study was to determine the effects of TXA on perioperative blood loss and drain output in patients undergoing primary total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA).

Methods: We conducted a retrospective comparison of 77 TSAs and 94 RTSAs performed in 168 patients.

Reverse Total Shoulder Arthroplasty for Posttraumatic Sequelae.

Objectives: The sequelae of proximal humeral fractures can produce severe shoulder dysfunction. We assessed the results of reverse shoulder arthroplasty (RSA) for these complex problems.

Design: Retrospective multicenter study.

Office-based rapid prototyping in orthopedic surgery: a novel planning technique and review of the literature.

Three-dimensional (3-D) prototyping, based on high-quality axial images, may allow for more accurate and extensive preoperative planning and may even allow surgeons to perform procedures as part of preoperative preparation. In this article, we describe 7 cases of complex orthopedic disorders that were surgically treated after preoperative planning that was based on both industry-provided models and use of our in-house 3-D printer. Commercially available 3-D printers allow for rapid in-office production of a high-quality realistic prototype at relatively low per-case cost.

Cost utility analysis of reverse total shoulder arthroplasty.

Background: Reverse shoulder arthroplasty provides satisfactory outcomes, but its cost-effectiveness is unproven. We prospectively analyzed outcomes and costs for primary reverse shoulder arthroplasty.

Methods: Thirty serial patients (16 women and 14 men; mean age, 74.

Reverse shoulder replacement for patients with inflammatory arthritis.

Purpose: Patients with inflammatory arthritis frequently develop destructive shoulder arthritis and rotator cuff tearing. Reconstruction with anatomical shoulder replacement produces lesser results than for other etiologies such as osteoarthritis. We postulated that reconstruction with reverse shoulder prostheses would lead to early satisfactory results for these patients.

Analysis of total joint arthroplasty costs in Chinese patients.

All charges for patients undergoing unilateral and bilateral hip or knee arthroplasties at 1 hospital in Beijing, China, were identified and assigned to 1 of 11 charge categories: hospital room, nursing, radiology, laboratory, anesthesia, surgery, prosthesis, pharmacy, blood transfusion, materials, and miscellaneous. The prosthesis and pharmacy charges at this institution accounted for approximately 80% of the total charges; compared with published data from institutions in North America and Taiwan, these 2 charges accounted for a greater percentage of total charges. In distinction, labor costs in China accounted for a lower percentage of total charges.

More hypotension in patients taking antihypertensives preoperatively during shoulder surgery in the beach chair position.

Purpose: Hypotension is common in patients undergoing surgery in the sitting position under general anesthesia, and the risk may be exacerbated by the use of antihypertensive drugs taken preoperatively. The purpose of this study was to compare hypotensive episodes in patients taking antihypertensive medications with normotensive patients during shoulder surgery in the beach chair position.

Methods: Medical records of all patients undergoing shoulder arthroscopy during a 44-month period were reviewed retrospectively.

Preoperative patient education reduces in-hospital falls after total knee arthroplasty.

Background: Inpatient hospital falls after orthopaedic surgery represent a major problem, with rates of about one to three falls per 1000 patient days. These falls result in substantial morbidity for the patient and liability for the institution.

Questions/purposes: We determined whether preoperative patient education reduced the rate of in-hospital falls after primary TKA and documented the circumstances and the injuries resulting from the falls.

The influence of postoperative acromial and scapular spine fractures on the results of reverse shoulder arthroplasty.

Fractures of the acromion or scapular spine are recognized complications of reverse arthroplasty. This study reviewed the outcome of reverse arthroplasties with such fractures and compared the results to arthroplasties without the fractures. A consecutive series of 125 reverse arthroplasties were reviewed for the development of a postoperative acromial or scapular spine fracture.