Structural bone grafting for glenoid bone loss in primary anatomic total shoulder arthroplasty: a case series and technique report.

Background: Posterior glenoid bone loss in glenohumeral osteoarthritis poses significant challenges in shoulder arthroplasty. Anatomic total shoulder arthroplasty (TSA) with a humeral head autograft to address the glenoid bone deficiency is an option for these difficult cases. Variable results with this procedure are reported in the literature.

A two-year comparison of reverse total shoulder arthroplasty mini-humeral tray and augmented mini-glenoid baseplate implants vs. standard implants.

Background: Patients who undergo reverse total shoulder arthroplasty (RTSA) are getting younger with greater function expectations. This retrospective, longitudinal study of prospectively collected data compared perceived shoulder function and strength, active shoulder mobility, radiographic evidence of scapular notching, and implant survival over the initial 2-years post-RTSA among patient groups who received either standard central fixation point liner and glenoid baseplate implants, or lower size profile mini-humeral tray with offset trunnion options and mini-augmented glenoid baseplate implants.

Materials And Methods: Patients who underwent primary RTSA using standard central fixation point liner and glenoid baseplate implants (Group 1, n = 180) were compared with patients who underwent primary RTSA using lower size profile mini-humeral tray with offset trunnion options and mini-augmented glenoid baseplate implants (Group 2, n = 53) for active shoulder mobility, American Shoulder and Elbow Surgeons (ASES) score, perceived ability to lift 10 lbs (4.

The effect of different antibiotic combinations in calcium sulfate cement on the growth of Cutibacterium acnes and Staphylococcus periprosthetic shoulder infection isolates.

Background: Periprosthetic joint infections (PJI) of the shoulder are a devastating complication of shoulder arthroplasty and are commonly caused by Staphylococcus and Cutibacterium acnes. Absorbable calcium sulfate (CS) beads are sometimes used for delivering antibiotics in PJI. This study evaluates the in vitro effect of different combinations of gentamicin, vancomycin, and ertapenem in beads made from CS cement on the growth of C acnes and coagulase-negative Staphylococcus (CNS) strains.

Greater Mental Health Burden is Associated With Poor Postoperative Pain Control and Increased Opioid Utilization Following Total Shoulder Arthroplasty.

Background: Prolonged opioid use is associated with higher complications and worse patient-reported outcomes following total shoulder arthroplasty (TSA). Identified risk factors for prolonged postoperative use are related to several medical comorbidities, gender, diagnoses of anxiety or depressive disorders, and preoperative opioid use. In this study, we hypothesized that patient-reported mental health characteristics can help to identify patients at risk of worse postoperative pain control, worse sleep, and higher opioid utilization following TSA.

Mini-augmented glenoid baseplate and mini-humeral tray reverse total shoulder arthroplasty implant comparisons: two-year clinical outcomes.

Background: Augmented glenoid baseplate and offset humeral tray reverse total shoulder arthroplasty (RTSA) implants may decrease the mechanical impingement that creates scapular notching and improve shoulder function. This study evaluated the clinical efficacy of three different RTSA glenoid baseplate and offset humeral tray combinations for patient-reported shoulder function, pain and instability, radiographic imaging evidence of glenoid baseplate or humeral stem subsidence and migration, bony changes associated with implant loosening, and scapular notching over the initial 2 years post-RTSA. Primary outcomes included active shoulder mobility, perceived function, pain, instability, scapular notching, and implant survival.

Stemless anatomic total shoulder arthroplasty: surgical technique and review of the literature.

Stemless anatomic total shoulder arthroplasty (aTSA) is a promising option for the treatment of degenerative disease in patients. This novel technique avoids the stem-related complications associated with the traditional stemmed aTSA. Stemless aTSA offers additional benefits such as decreased operative time, preservation of bone stock, improved radiographic outcomes, and easier revision.

Factors affecting internal rotation following total shoulder arthroplasty.

Background: Reverse shoulder arthroplasty (RSA) was developed in the late twentieth century to provide a stable arthroplasty option for patients with rotator cuff deficiency arthropathy. Since its inception, there have been changes in materials, design, and positioning. One of the persistent clinical issues has been difficulty with internal rotation (IR) and the associated difficulty with behind the back activities.

Optimizing glenoid bone preservation in reverse total shoulder arthroplasty using augmented baseplates.

Background: As techniques and implants for reverse total shoulder arthroplasty (rTSA) evolve, a greater emphasis is being placed on preserving glenoid bone stock and optimizing shoulder biomechanics. Augmented baseplates preserve glenoid bone and improve shoulder range of motion by lateralizing the center of rotation of the glenosphere, while also reducing postoperative complications after rTSA. The technique for bone preservation with use of augmented baseplates in the absence of bone loss and the outcomes of a series of cases are contained in this report.

Reverse shoulder arthroplasty using an onlay humeral prosthesis, offset humeral tray, and augmented glenoid baseplate: surgical technique and review of the impact of prosthesis design on scapular fractures following reverse shoulder arthroplasty.

Reverse total shoulder arthroplasty (RSA) has become the most utilized form of arthroplasty of the shoulder. Acromial stress fractures and scapular spine stress fractures are rare, yet well-recognized complications of RSA with ongoing studies identifying whether patient factors or prosthetic designs serve as risk factors. Specifically, it remains unclear if or how the position of the humeral tray (inlay or onlay) in RSA affects rates of periscapular fractures.

In vitro and in vivo assessment of extended duration cathodic voltage-controlled electrical stimulation for treatment of orthopedic implant-associated infections.

Effective treatment of orthopedic implant-associated infections (IAIs) remains a clinical challenge. The in vitro and in vivo studies presented herein evaluated the antimicrobial effects of applying cathodic voltage-controlled electrical stimulation (CVCES) to titanium implants inoculated with preformed bacterial biofilms of methicillin-resistant Staphylococcus aureus (MRSA). The in vitro studies showed that combining vancomycin therapy (500 µg/mL) with application of CVCES at -1.

Outcomes of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fracture Using Uncemented Stems, a Single Center Study.

Background: To evaluate the clinical, functional, radiographic, and survival outcomes in patients undergoing reverse total shoulder arthroplasty (RSA) with uncemented stem fixation for proximal humerus fractures.

Materials And Methods: This is a retrospective cohort study that evaluated a consecutive series of patients with proximal humerus fractures undergoing RSA. Clinical data, radiographs, and re-operation rates were reviewed in patients selected for uncemented stem fixation.

Reverse total shoulder arthroplasty baseplate stability with locking vs. non-locking peripheral screws.

Background: There are many options for glenosphere baseplate fixation commercially available, yet there is little biomechanical evidence supporting one type of fixation over another. In this study, we compared the biomechanical fixation of a reverse total shoulder glenoid baseplate secured with locking or non-locking peripheral screws.

Methods: Both a non-augmented mini baseplate with full backing support and an augmented baseplate were testing after implantation in solid rigid polyurethane foam.

Reverse Total Shoulder Arthroplasty Baseplate Stability in Superior Bone Loss With Augmented Implant.

Background: Glenoid bone loss is commonly encountered in cases of rotator cuff tear arthropathy and can create challenges during reverse shoulder arthroplasty. In this study, we sought to investigate the biomechanical properties of a new treatment option for superior glenoid defect, an augmented reverse total shoulder baseplate.

Methods: Three conditions were examined: non-augmented baseplate without defect, non-augmented baseplate with defect, and augmented baseplate with defect.

Hybrid fixation in anatomic shoulder arthroplasty: surgical technique and review of the literature.

Hybrid constructs have been used as a primary fixation technique in primary anatomic total shoulder arthroplasty for more than a decade. A highly porous metal central peg, metal cage, or coatings attached to the surface of cemented polyethylene glenoid component have been used with the concept of providing an additional adjunct in promoting osseointegration, preventing glenoid component loosening, and promoting longer-term success. The purpose of this article is to analyze the published results, complications, as well as rate of revision using this form of glenoid fixation.

Prospective, Blinded, Randomized Controlled Trial of Stemless Versus Stemmed Humeral Components in Anatomic Total Shoulder Arthroplasty: Results at Short-Term Follow-up.

Background: Stemless humeral components for anatomic total shoulder arthroplasty (aTSA) have several reported potential benefits compared with stemmed implants. However, we are aware of no Level-I, randomized controlled trials (RCTs) that have compared stemless implants with stemmed implants in patients managed with aTSA. We sought to directly compare the short-term clinical and radiographic outcomes of stemless and stemmed implants to determine if the stemless implant is noninferior to the stemmed implant.

Effect of Blue Light and Photosensitizers on on Shoulder Periprosthetic Joint Infection Isolates.

is gaining recognition as a leading pathogen after orthopaedic shoulder procedures. Photodynamic therapy, a combination of light and a photosensitizer, has demonstrated antimicrobial activity against in the treatment of acne vulgaris. We sought to evaluate the effect of photodynamic therapy using blue light and photosensitizers on isolates from shoulder prosthetic joint infections.

Pathogenic genetic variations of C. acnes are associated with clinically relevant orthopedic shoulder infections.

Many surgeons continue to face the clinical dilemma of interpreting a positive aspiration or unexpected positive Cutibacterium acnes (C. acnes) culture. There are factors that complicate the interpretation of positive cultures including variations in both frequency of false positive cultures and virulence properties.

Running Out of Room: Managing Humeral and Glenoid Bone Loss in Shoulder Arthroplasty.

Glenoid bone loss is frequently encountered in arthritic conditions. The Walch classification is commonly used to categorize glenoid bone loss into several different types. Preoperative CT can assist in identifying the type and extent of bone loss for development of the appropriate treatment plan.

Outcomes of Uncemented Versus Cemented Reverse Shoulder Arthroplasty for Proximal Humerus Fractures.

Reverse shoulder arthroplasty (RSA) for proximal humerus fractures (PHFs) is traditionally performed with cemented humeral fixation. The purpose of this study was to compare the clinical and radiographic outcomes of cemented and cementless RSA for PHF. Between 2010 and 2014, 38 acute PHFs were treated with RSA and followed for a minimum of 2 years (mean, 37 months; range, 24-66 months).

Hemolysis Is a Diagnostic Adjuvant for Propionibacterium acnes Orthopaedic Shoulder Infections.

Introduction: The purpose of this study was to further evaluate the pathogenicity of hemolytic and nonhemolytic phenotypes of Propionibacterium acnes (P acnes) isolates from shoulders of orthopaedic patients.

Methods: Thirty-one patient records were reviewed, which had a positive P acnes shoulder culture from joint aspiration fluid and/or intraoperative tissues for demographics, clinical course, culture, and laboratory data. Patients were categorized as definite infection, probable infection, or probable contaminant.

Antibiotic Prophylaxis and Prevention of Surgical Site Infection in Shoulder and Elbow Surgery.

Infection after orthopedic procedures is a devastating and serious complication associated with significant clinical and financial challenges to the health care system and unfortunate patient. The time and resource-intensive nature of treating infection after orthopedic procedures has turned attention toward enhancing prevention and establishing quality improvement measures. Prevention strategies throughout the perioperative period include host optimization, risk mitigation, reducing bacterial burden and proper wound management.

Host Inflammatory Response During Periprosthetic Infection Is Joint Specific.

Background: () has become increasingly recognized as a cause of periprosthetic joint infection (PJI).

Questions/purposes: It is not currently known if the clinical presentation of varies depending on the joint being infected.

Methods: We retrospectively reviewed patients infected with after total hip, knee, and shoulder arthroplasty from two institutions.