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: A retrospective case-controlled study was performed to evaluate the outcomes of shoulder arthroplasty performed as a day case in carefully selected patients, compared to the traditional inpatient approach. : Patients who had total or hemiarthroplasty of the shoulder performed as a day case or inpatient procedure were recruited. The primary outcome compared rates of uneventful recovery, defined by the absence of complications or readmission to the hospital within six months of surgery, between the inpatient and outpatient groups. Secondary outcomes included examiner-determined functional and patient-determined pain scores at one, six, twelve, and twenty-four weeks post-surgery. A further assessment of patient-determined pain scores was carried out at least two years post-surgery (5.8 ± 3.2). : 73 patients (36 inpatients and 37 outpatients) were included in the study. Within this time frame, 25/36 inpatients (69%) had uneventful recoveries compared to 24/37 outpatients (65%) ( = 0.17). Outpatients showed significant improvement over pre-operative baseline levels in more secondary outcomes (strength and passive range-of-motion) by six months post-operation. Outpatients also performed significantly better than inpatients in external rotation ( < 0.05) and internal rotation ( = 0.05) at six weeks post-surgery. Both groups showed significant improvement compared to pre-operative baselines in all patient-determined secondary outcomes except the activity level at work and sports. Inpatients, however, experienced less severe pain at rest at six weeks ( = 0.03), significantly less frequent pain at night ( = 0.03), and extreme pain ( = 0.04) at 24 weeks, and less severe pain at night at 24 weeks ( < 0.01). By a minimum of two years post-operation, inpatients were more comfortable repeating their treatment setting for future arthroplasty (16/18) compared to outpatients (7/22) ( = 0.0002). : At a minimum of two years of follow-up, there were no significant differences in rates of complications, hospitalizations, or revision surgeries between patients that underwent shoulder arthroplasty as an inpatient versus an outpatient. Outpatients demonstrated superior functional outcomes but reported more pain at six months post-surgery. Patients in both groups preferred inpatient treatment for any future shoulder arthroplasty. Shoulder arthroplasty is a complex procedure and has traditionally been performed on an inpatient basis, with patients admitted for six to seven days post-surgery. One of the primary reasons for this is the high level of post-operative pain, usually treated with hospital-based opioid therapy. Two studies demonstrated outpatient TSA to have a similar rate of complications as inpatient TSA; however, these studies only examined patients within a shorter-term 90-day post-operative period and did not evaluate functional outcomes between the two groups or in the longer term. This study provides evidence supporting the longer-term results of shoulder arthroplasty done as a day case in carefully selected patients, which are comparable to outcomes in patients that are admitted to the hospital post-surgery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10298933 | PMC |
http://dx.doi.org/10.3390/jcm12123886 | DOI Listing |
J Shoulder Elbow Surg
December 2024
Department of Orthopaedics, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
Background: Reverse total shoulder arthroplasty (RTSA) is considered a promising surgical procedure, and several studies have reported its advantages in improving shoulder elevation. However, patients undergoing RTSA may still experience challenges related to rotational movements. While external rotation may be improved with lateralization, internal rotation may occasionally deteriorate after RTSA.
View Article and Find Full Text PDFJ Shoulder Elbow Surg
December 2024
Orthopedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA. Electronic address:
Background: The restriction of active internal rotation (IR) after reverse shoulder arthroplasty (RSA) poses a challenging problem for reconstructive shoulder surgeons, particularly in patients suffering from massive rotator cuff tears (mRCT) with subscapularis (SSC) deficiency. This study aims to evaluate the biomechanical effectiveness of different tendon transfer techniques following medialized glenoid and lateralized humerus RSA in improving internal rotation (IR) strength.
Methods: Eight cadaveric shoulder specimens were evaluated using a custom shoulder testing system designed to simulate loading conditions typical of mRCT with SSC insufficiency.
J Shoulder Elbow Surg
December 2024
Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
Background: Operating room (OR) efficiency is of paramount importance for scheduling, cost efficiency and to allow for the high operating volume required to address the growing demand for arthroplasty. The purpose of this study was to develop a machine learning predictive model for Total Shoulder Arthroplasty (TSA) procedure duration and to identify factors which are predictive of a prolonged procedure.
Methods: A retrospective review was undertaken of all TSA between 2013-2021 in a large academic institution.
PLoS One
December 2024
Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland.
Background: This study aims to report and analyze disease-specific patient-reported outcome measure (PROM) effect size (ES) variations, in patients undergoing major arthroplasty surgery.
Material And Methods: All institution-based data of primary knee, hip, or shoulder arthroplasty patients at Turku University hospital (Finland) between January 2020 -December 2022 were collected, and treatment outcome assessed as a PROM difference between baseline and one-year follow-up. PROM ES were calculated for each patient and patient group separately, and patients with ES >0.
Shoulder Elbow
December 2024
Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA.
Background: This study investigates the association between the Geriatric Nutritional Risk Index (GNRI), a simple readily available measure of malnutrition risk, and 30-day postoperative complications following revision total shoulder arthroplasty (TSA).
Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015 and 2022. The study population was divided into three groups based on preoperative GNRI: normal/reference (GNRI > 98), moderate malnutrition (92 ≤ GNRI ≤ 98), and severe malnutrition (GNRI < 92).
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