American Academy of Orthopaedic Surgeons Appropriate Use Criteria for Humeral Component Design During Primary Anatomic Total Shoulder Arthroplasty.

The American Academy of Orthopaedic Surgeons (AAOS) has developed appropriate use criteria (AUC) for humeral component design during primary anatomic total shoulder arthroplasty. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to determine the appropriateness of various humeral component designs during primary anatomic total shoulder arthroplasty. The AUC for humeral component design during primary anatomic total shoulder arthroplasty w ere derived by identifying clinical indications evident during the clinical decision-making process.

Procedure Cost Comparison of Outpatient and Inpatient Shoulder Arthroplasty and Lower-Extremity Arthroplasty Within a Managed-Care Organization.

Introduction The authors sought to evaluate cost differences between shoulder arthroplasties and lower-extremity joint replacements in the outpatient and inpatient setting within a large health-maintenance organization. Methods A cross-sectional study of 100 total hip arthroplasties (THA), 100 total knee arthroplasties (TKA), and 100 shoulder arthroplasties (50 anatomical total shoulder arthroplasties and 50 reverse shoulder arthroplasties [RTSA]) was performed at a single regional health care center within an integrated health care maintenance organization. A time-driven activity-based costing methodology was used to obtain total cost of each episode for outpatient (vs) inpatient surgery.

Tranexamic acid is not associated with decreased infection risk after primary shoulder arthroplasty: a cohort study of 9276 patients.

Background: The use of tranexamic acid (TXA) is associated with less blood loss and reduced transfusion risk after shoulder arthroplasty surgery. Recent studies have shown lower odds of postoperative infection after hip or knee arthroplasty with its use. The purpose of this study was to determine whether TXA use reduces the risk of infection after primary elective shoulder arthroplasty.

Temporal Trends in Deep Surgical Site Infections After Six Orthopaedic Procedures Over a 12-year Period Within a US-based Healthcare System.

Introduction: Centers of excellence and bundled payment models have driven perioperative optimization and surgical site infection (SSI) prevention with decolonization protocols and antibiotic prophylaxis strategies. We sought to evaluate time trends in the incidence of deep SSI and its causative organisms after six orthopaedic procedures in a US-based integrated healthcare system.

Methods: We conducted a population-level time-trend study using data from Kaiser Permanente's orthopaedic registries.

Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response.

Background: There is no consensus on the treatment of irreparable massive rotator cuff tears. The goal of this systematic review and meta-analysis was to (1) compare patient-reported outcome scores, (2) define failure and reoperation rates, and (3) quantify the magnitude of patient response across treatment strategies.

Methods: The MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Scopus databases were searched for studies including physical therapy and operative treatment of massive rotator cuff tears.

The association between glenoid component design and revision risk in anatomic total shoulder arthroplasty.

Introduction: Anatomic total shoulder arthroplasty (TSA) is a proven treatment for glenohumeral joint osteoarthritis, with superior results compared with hemiarthroplasty. However, glenoid component loosening remains a problem and is one of the most common causes of failure in TSA. Multiple component designs have been developed in an attempt to reduce loosening rates.

Defining massive rotator cuff tears: a Delphi consensus study.

Background: A standard definition for massive rotator cuff tears (MRCTs) has not been identified. The purpose of this study is to use the modified Delphi technique to determine a practical, consensus definition for MRCTs.

Methods: This study is based on responses from 20 experts who participated in 4 rounds of surveys to determine a consensus definition for MRCT.

Predicting Failure After Primary Arthroscopic Bankart Repair: Analysis of a Statistical Model Using Anatomic Risk Factors.

Purpose: The purpose of this study was to establish and analyze a simplified scoring system based on anatomic imaging measurements to predict recurrent instability after primary arthroscopic shoulder capsulolabral repair.

Methods: All patients undergoing primary arthroscopic anterior capsulolabral repair of the shoulder were reviewed. Patients were contacted and charts were reviewed for endpoint of recurrent instability and return to prior level of activity.

Perioperative Clindamycin Use in Penicillin Allergic Patients Is Associated With a Higher Risk of Infection After Shoulder Arthroplasty.

Background: This study determines whether infection rates differ between prophylactic antibiotic use for patients with or without penicillin allergy before shoulder arthroplasty surgery.

Methods: Seven thousand one hundred forty primary shoulder arthroplasties operated between 2005 and 2016 were identified. We compared deep surgical site infection risk of patients who received perioperative vancomycin alone (6.

Evaluating Glenohumeral Osteoarthritis: The Relative Impact of Patient Age, Activity Level, Symptoms, and Kellgren-Lawrence Grade on Treatment.

Background: It is not always clear how to treat glenohumeral osteoarthritis, particularly in young patients. The goals of this study were to 1) quantify how patient age, activity level, symptoms, and radiographic findings impact the decision-making of shoulder specialists and 2) evaluate the observer reliability of the Kellgren-Lawrence (KL) grading system for primary osteoarthritis of the shoulder.

Methods: Twenty-six shoulder surgeons were each sent 54 simulated patient cases.

Risk Factors for Mortality and Readmission After Shoulder Hemiarthroplasty for Fracture.

Background: Limited information exists regarding mortality and readmission following proximal humerus fracture. This study examines risk factors following hemiarthroplasty for these fractures.

Methods: A retrospective analysis of prospectively collected data on 788 patients treated with hemiarthroplasty for acute proximal humerus fracture from January 2005 to December 2011 was conducted.

Operative Management of Acute Triceps Tendon Ruptures: Review of 184 Cases.

Background: Distal triceps tendon ruptures are rare. The authors present a series of 184 surgically treated, acute, traumatic triceps tendon avulsions and compare the complications between those treated with anchors (A) versus transosseous (TO) suture repair.

Hypothesis: No difference exists in the retear rate between TO and A repairs.

Anterior deltoid reeducation for irreparable rotator cuff tears revisited.

Background: A previous study introduced a method of conservative treatment of irreparable rotator cuff tears (RCTs) using a rehabilitation program (anterior deltoid reeducation [ADR]). The purposes of this study were to present our experience with ADR and to compare our results with those of the previous study.

Methods: Thirty consecutive elderly patients with irreparable RCTs were prospectively enrolled and taught how to perform the home-based ADR program for a period of 3 months.

Complications in total shoulder and reverse total shoulder arthroplasty by body mass index.

Introduction: The purpose of this study was to identify the effects of body mass index (BMI) on long-term outcomes (revision rate, 1-year mortality rate, 3-year surgical site infection rate, and 90-day inpatient all-cause readmission rate) after total shoulder arthroplasty (TSA) and reverse TSA (RTSA).

Methods: A large shoulder arthroplasty registry was used to review outcomes after TSA and RTSA. The registry monitors patient's revision, mortality, infection, and readmission rates.

Yearly Trends in Elective Shoulder Arthroplasty, 2005-2013.

Objective: To evaluate the change in incidence rate of shoulder arthroplasty, the utilization of shoulder arthroplasty for specific indications, and the surgeon volume trends associated with these procedures between 2005 and 2013.

Methods: A population-based cohort study was conducted using the more than 7 million members of an integrated health care system in California. Cases of shoulder arthroplasties performed between 2005 and 2013 were identified using a shoulder arthroplasty registry.

Cement technique correlates with tuberosity healing in hemiarthroplasty for proximal humeral fracture.

Background: Tuberosity healing correlates with clinical outcomes after hemiarthroplasty for 4-part proximal humeral fractures (4PHFs). We seek to examine variables that affect tuberosity healing.

Methods: This was a retrospective comparative study.

Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques.

Aims: To compare radiographic failure and re-operation rates of anatomical coracoclavicular (CC) ligament reconstructional techniques with non-anatomical techniques after chronic high grade acromioclavicular (AC) joint injuries.

Patients And Methods: We reviewed chronic AC joint reconstructions within a region-wide healthcare system to identify surgical technique, complications, radiographic failure and re-operations. Procedures fell into four categories: (1) modified Weaver-Dunn, (2) allograft fixed through coracoid and clavicular tunnels, (3) allograft loop coracoclavicular fixation, and (4) combined allograft loop and synthetic cortical button fixation.

Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures in a Community-Based Health Care Organization.

Context: Surgical treatment for proximal humerus fractures has increased exponentially. Recent health care policies incentivize centers to reduce hospital readmission rates. Better understanding of risk factors for readmission and early mortality in this population will assist in identifying favorable risk-benefit patient profiles.

Incidence of symptomatic compressive peripheral neuropathy after shoulder replacement.

Background: The incidence of post-operative compressive peripheral neuropathy (CPN) after shoulder arthroplasty is not known. We hypothesized that the likelihood following shoulder arthroplasty would be higher compared to a non-operative cohort.

Methods: Retrospective study compared the incidence of symptomatic CPN after shoulder replacement to a 1:1 age- and gender-matched non-operative control group with shoulder arthritis.

The Kaiser Permanente shoulder arthroplasty registry: results from 6,336 primary shoulder arthroplasties.

Background And Purpose: Shoulder arthroplasty is being performed in the United States with increasing frequency. We describe the medium-term findings from a large integrated healthcare system shoulder arthroplasty registry.

Patients And Methods: Shoulder arthroplasty cases registered between January 2005 and June 2013 were included for analysis.

Patient and procedure-specific risk factors for deep infection after primary shoulder arthroplasty.

Background: Deep infection after shoulder arthroplasty is a diagnostic and therapeutic challenge. The current literature on this topic is from single institutions or Medicare samples, lacking generalizability to the larger shoulder arthroplasty population.

Questions/purposes: We sought to identify (1) patient-specific risk factors for deep infection, and (2) the pathogen profile after primary shoulder arthroplasty in a large integrated healthcare system.

The effect of surgeon and hospital volume on shoulder arthroplasty perioperative quality metrics.

Background: There has been a significant increase in both the incidence of shoulder arthroplasty and the number of surgeons performing these procedures. Literature regarding the relationship between surgeon or hospital volume and the performance of modern shoulder arthroplasty is limited. This study examines the effect of surgeon or hospital shoulder arthroplasty volume on perioperative metrics related to shoulder hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty.

Shoulder arthroplasty in patients 59 years of age and younger.

Background: While shoulder arthroplasty is a well established treatment for a variety of conditions about the shoulder, the results of shoulder replacement in younger patients are not as predictable. The purpose of this study is to examine the indications for shoulder arthroplasty in patients 59 years old and younger, and to analyze revision rates between younger and older patients.

Methods: This is a retrospective cohort study of shoulder arthroplasties performed within a statewide integrated healthcare system between 2005 and 2010.

Risk of thromboembolism in shoulder arthroplasty: effect of implant type and traumatic indication.

Background: Prior research about symptomatic venous thromboembolism (VTE) after shoulder arthroplasty has not determined whether procedure type (hemiarthroplasty, total shoulder arthroplasty, or reverse shoulder arthroplasty) or surgical indication (traumatic or elective) represent risk factors for VTE after shoulder replacement.

Questions/purposes: We therefore asked whether the risk of symptomatic VTE events and mortality within 90 days of shoulder arthroplasty was influenced by (1) procedure type, and (2) surgical indication (traumatic or elective).

Methods: We performed a retrospective database review of symptomatic VTE events and mortality within 90 days of shoulder arthroplasty in a large (30-hospital) integrated healthcare system over a 5-year period, from January 2005 to December 2009.