Does the Relationship Between Preoperative Function and Achievement of Clinically Important Benchmarks of Success After Total Shoulder Arthroplasty Depend on Outcome Assessment Design?

Background: A variety of clinically important benchmarks of success (CIBS) have been defined for total shoulder arthroplasty (TSA) to quantify success. However, it is unclear how the preoperative status of the patient influences their likelihood of achieving each CIBS.

Questions/purposes: (1) What proportion of patients achieve commonly used CIBS after TSA? (2) Is there a relationship between a patients' preoperative function and their probability of achieving different CIBS? (3) Does there exist preoperative ranges for each outcome measure that are associated with greater achievement of CIBS?

Methods: We retrospectively queried a multicenter shoulder arthroplasty database for primary anatomic TSA (aTSA) and reverse TSA (rTSA).

Pain Relief Survivorship: A Comparison of Exactech Equinoxe Anatomic and Reverse Total Shoulder Arthroplasty for Primary Osteoarthritis.

Background: Pain-relief plays a major deterministic role when assessing postoperative patient satisfaction; however, whether anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA) provides the most durable pain-relief has not been studied. The purpose of this study was to evaluate the durability of pain-relief after aTSA compared to rTSA in patients undergoing surgery for rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA).

Methods: A retrospective review of a multicenter shoulder arthroplasty database (Exactech Equinoxe) was performed.

Passing American Board of Orthopedic Surgery Part II.

Successfully completing the American Board of Orthopedic Surgery Part II oral examination process is the final milestone in becoming a board-certified orthopedic surgeon. This nearly 2 year process requires adequate planning and preparation to ensure the best chances of success. Maintaining evidence-based practices in clinical and surgical decision making is essential for maximizing success as well.

Navigating Contract Negotiations.

Negotiating a first contract can be a stressful experience for soon-to-be early-career physicians. Most trainees do not have extensive experience with the contract negotiation process, and this unfamiliarity often breeds a lack of confidence and anxiety. However, understanding some key points and the general mechanics of a contract will help bridge any areas of uncertainty.

Does robotic-assisted unicompartmental knee arthroplasty improve alignment and outcomes?

Unicompartmental knee arthroplasty (UKA) continues to increase in popularity as an excellent option for patients with single compartment disease. Robotic-assisted UKA has emerged as an optional tool with hopes for improvement in component placement, limb alignment, and patient outcomes. Furthermore, as patients continue to educate themselves, robotic assistance will become increasingly prevalent.

Incidence of Vitamin D Deficiency in Foot and Ankle Arthrodesis Nonunions.

Background Vitamin D has been found to be crucial in musculoskeletal health. The role of vitamin D levels in orthopedic patients has become a growing area of interest given its negative impact on fracture healing which can contribute to the development of nonunion following surgery. We sought to investigate the incidence of hypovitaminosis D in a cohort of patients who experienced a nonunion following a foot and ankle arthrodesis procedure.

Excellent 10-Year survivorship of robotic-arm-assisted unicompartmental knee arthroplasty.

Introduction: Robotic-arm-assisted unicompartmental knee arthroplasty (UKA) is an excellent solution for patients suffering from single-compartment knee arthritis. While outcomes tend to be favorable for UKAs, revision operations, commonly due to component malpositioning and malalignment resulting in accelerated wear, are a major concern. Intraoperative technologies, such as robotic assistance, can help better ensure that implants are positioned based on a patient's specific anatomy and mechanical physiology.

Three-dimensional-based native alignment phenotype classification system: Description for use in planning for deformities during total knee arthroplasty.

Introduction: Total knee arthroplasty (TKA) is a complex surgical procedure that traditionally relies on two-dimensional radiographs for pre-operative planning. These radiographs may not capture the intricate details of individual knee anatomy, potentially limiting the precision of surgical interventions. With advancements in imaging technology, there is an opportunity to refine TKA outcomes.

Significant Cost Savings and Improved Early Clinical Outcomes in Medicare Patients Utilizing a Clinician-Controlled Telerehabilitation System Following Total Knee Arthroplasty.

Background: The costs and benefits of different rehabilitation protocols following total knee arthroplasty are unclear. The emergence of telerehabilitation has introduced the potential for enhanced patient convenience and cost reduction. The purpose of this study was to assess the cost difference between standard physical therapy (SPT) and a telerehabilitation home-based clinician-controlled therapy system (HCTS).

Clinical applications of robotic surgery platforms: a comprehensive review.

Robotic surgery has expanded globally across various medical specialties since its inception more than 20 years ago. Accompanying this expansion were significant technological improvements, providing tremendous benefits to patients and allowing the surgeon to perform with more precision and accuracy. This review lists some of the different types of platforms available for use in various clinical applications.

Kinematic Parameters Predictive of Pitch Velocity in Youth to Professional Baseball Pitchers: A Qualitative Systematic Review.

Background: Specific kinematic factors have been found to contribute to faster pitch speeds, with poor mechanics leading to injury.

Purpose: To discuss the kinematic parameters that predict faster ball velocity among baseball pitchers.

Study Design: Systematic review.

Artificial Intelligence and Machine Learning in Rotator Cuff Tears.

Rotator cuff tears (RCTs) negatively impacts patient well-being. Artificial intelligence (AI) is emerging as a promising tool in medical decision-making. Within AI, deep learning allows to autonomously solve complex tasks.

Quantifying success after first revision reverse total shoulder arthroplasty: the minimal and substantial clinically important percentage of maximal possible improvement.

Background: When patients require reoperation after primary shoulder arthroplasty, revision reverse total shoulder arthroplasty (rTSA) is most commonly performed. However, defining clinically important improvement in these patients is challenging because benchmarks have not been previously defined. Furthermore, although the minimal clinically important difference and substantial clinical benefit are commonly used to assess clinically relevant success, these metrics are limited by ceiling effects that may cause inaccurate estimates of patient success.

Quantifying success after reverse total shoulder arthroplasty: the substantial clinically important percentage of maximal possible improvement.

Background: Changes in preoperative to postoperative outcome scores are often used to quantify success after reverse total shoulder arthroplasty (rTSA). However, ceiling effects associated with many outcome scores limit the ability to differentiate success among high-functioning patients. The percentage of maximal possible improvement (%MPI) was introduced to simplify and better stratify patient success.

Quantifying success after anatomic total shoulder arthroplasty: the substantial clinically important percentage of maximal possible improvement.

Background: Percentage maximal possible improvement (%MPI) has been described as a threshold by which to evaluate patient improvement after anatomic total shoulder arthroplasty (aTSA) that has favorable psychometric properties. The primary purpose of this study was to define the percentage maximal possible improvement (%MPI) thresholds associated with substantial clinical improvement following primary anatomic total shoulder arthroplasty (aTSA) and compare the rates of success as defined by those achieving the substantial clinical benefit (SCB) compared with the 30% MPI for different outcome scores.

Methods: A retrospective review was performed of an international shoulder arthroplasty database between 2003 and 2020.

Quantifying success after first revision reverse total shoulder arthroplasty: the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state.

Background: When patients require revision of primary shoulder arthroplasty, revision reverse total shoulder arthroplasty (rTSA) is most commonly performed. However, defining clinically important improvement in these patients is challenging because benchmarks have not been previously defined. Our purpose was to define the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for outcome scores and range of motion (ROM) after revision rTSA and to quantify the proportion of patients achieving clinically relevant success.

Forearm Pronation at Foot Contact: A Biomechanical Motion-Capture Analysis in High School and Professional Pitchers.

Background: It has previously been speculated that baseball pitchers who display excessive forearm pronation at foot contact (FC) have a higher propensity toward ulnar collateral ligament injury and subsequent surgery.

Purpose: To evaluate the association between degree of forearm pronation/supination at FC and throwing arm kinetics in high school and professional pitchers, at both the individual (intrapitcher) and the group (interpitcher) level.

Study Design: Descriptive laboratory study.

Short-term radiographic analysis of a stemless humeral component for anatomic total shoulder arthroplasty.

Background: Standard stemmed humeral implants have traditionally been utilized for total shoulder arthroplasty (TSA) with a recent trend to implant smaller stems including short and stemless humeral designs. However, the rate of stress shielding after stemless TSA has not been primarily studied. Therefore, the objective of this study is to report the short-term survivorship and radiographic analysis of a stemless humeral implant.

Mid-Term Survivorship, Radiographic and Functional Outcomes of Robotic-Assisted Unicompartmental Knee Arthroplasty.

Introduction: The use of robotic-arm assistance for medial unicompartmental knee arthroplasty (RAUKA) has become an area of interest to overcome technical challenges, improve accuracy, and optimize patient outcomes. Due to the rise in osteoarthritis (OA) and robotic assistance, well-powered long-term studies are warranted. The aim of this study was to analyze midterm survivorship, radiographic changes, range of motion (ROM), and patient-reported outcome measurements (PROMs) of RAUKA.

Increased Pitch Velocity Is Associated With Throwing Arm Kinetics, Injury Risk, and Ulnar Collateral Ligament Reconstruction in Adolescent, Collegiate, and Professional Baseball Pitchers: A Qualitative Systematic Review.

Purpose: To assess the relationship between pitch velocity and throwing arm kinetics, injury, and ulnar collateral ligament reconstruction (UCLr) among high school, collegiate, and professional baseball pitchers.

Methods: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008-2019), and OVID/MEDLINE (2008-2019) were queried for articles that reported on pitch velocity predicting throwing arm kinetics, injury, or UCLr. The Methodological Index for Non-randomized Studies checklist was used to evaluate the quality of all included studies.

Risk of Periprosthetic Joint Infection After Intra-Articular Corticosteroid Injection Following Unicompartmental Knee Arthroplasty.

Background: Perioperative intra-articular joint injection is a known risk factor for developing prosthetic joint infection (PJI) in the immediate preoperative and postoperative periods for total knee arthroplasty, but is less defined in unicompartmental knee arthroplasty (UKA). The goal of this study was to elucidate the risk of developing PJI after intra-articular corticosteroid injection (IACI) into a post UKA knee.

Methods: A retrospective review of a nationwide administrative claims database was performed from January 2015 to October 2020.

A Home-Based, Remote-Clinician-Controlled, Physical Therapy Device Leads to Superior Outcomes When Compared to Standard Physical Therapy for Rehabilitation After Total Knee Arthroplasty.

Background: The optimal postoperative rehabilitation regimen following total knee arthroplasty (TKA) is not clearly defined. The advent of telerehabilitation offers potential for increased patient convenience and decreased cost, while maintaining similar outcomes to traditional physical therapy (PT). Therefore, we evaluated a novel, home-based, clinician-controlled, multi-modal evaluation and therapy device with telerehabilitation functionality for TKA.