Number Of Shoulder Arthroplasties Research Articles

What to expect after revision shoulder arthroplasty? A comprehensive review of the literature.

The number of shoulder arthroplasties has increased tremendously over the last twenty years, creating a proportional increase in complications rates and revision. Shoulder arthroplasty surgeon should have a clear understanding of the reasons for failure based on the specific index procedure that was performed. The main challenge includes the need for component removal and managing glenoid and humeral bone defects. This manuscript aims to outline the most common indications for revision surgery and treatment options based on a careful and detailed review of the available literature. This paper should help the surgeon in patient evaluation and selection of the optimal procedure for an individual patient.

Survivorship of Anatomic Total Shoulder Arthroplasty.

Anatomic total shoulder arthroplasty provides pain relief and improved quality of life for patients suffering from glenohumeral arthritis. The 10-year survival rate for these implants has been most recently reported at 96%. As the number of shoulder arthroplasties per year increases, it is important to evaluate factors associated with failure. Patient-specific variables such as age, sex, medical comorbidities, a history of previous shoulder surgery, and rotator cuff integrity can influence implant survival. Both surgeon and hospital volume have been shown to affect perioperative outcomes. Implant design and glenoid pathoanatomy are important structural considerations because both have a causal relationship with survivorship. Modifiable factors, such as smoking, body mass index, and alcohol or opioid consumption, should be addressed preoperatively when possible. Modifiable factors that pertain to surgery are equally as important; it is the responsibility of the surgeon to be aware of the reported outcomes for varying implants and technique-related pearls and pitfalls. For those perioperative factors that are nonmodifiable, it is prudent to counsel patients accordingly because these individuals may be more likely to require an eventual revision procedure.

Does revision shoulder arthroplasty increase your risk of opioid use and dependence?

As the number of shoulder arthroplasties (SA) increased exponentially over the past 2 decades, so have associated complications and revision surgery rates. Pain control after revision surgery can be difficult to manage given patients are not typically opioid naïve, however, to date opioid usage after revision SA has not been studied. The purpose of our study was to compare opioid use and dependence after revision SA to a primary SA cohort. A retrospective review was performed of revision and primary SA patients at a single institution from 2014 to 2016. The cohort was divided into 2 groups: primary ( n = 82) and revision ( n = 80) SA patients. Demographics including age, sex, BMI, ASA class and smoking status were collected. Opioid consumption within 90 days of SA was collected for the preoperative and postoperative period using a state drug monitoring registry and converted to total morphine equivalence (TME) for analyses. Opioid dependence was defined as ≥2 opioid prescriptions within 3 months. Analysis of Variance was used to compare TME between groups and Chi square test was used for categorical variables. Logistic regression analyses were performed to determine impact of various risk factors on postoperative opioid dependence. Demographics were similar between the 2 groups for BMI ( P =.73), sex ( P = .51), smoking status ( P = .49) and ASA class ( P = .96). There was a significant difference with the revision group having an average younger age (66.0 revision, 70.1 primary; P = .005). The mean preoperative TME was significantly higher for revision SA cohort (115.2) compared to the primary SA cohort (31.5) and postoperatively 188.7 for the revision SA cohort compared to an average of 117 for the primary cohort ( P < .001). The revision SA group had significantly more patients with preoperative dependence (38.8%) compared to 19.5% for the primary cohort ( P = .006) and postoperative dependence 43.8% ( n = 35) compared to 29.3% ( n = 24) patients in the primary group ( P = .04). Revision SA patients have higher rates of preoperative and postoperative opioid usage and dependence when compared to primary SA. Preoperatively dependent revision patients are more likely to remain dependent in the postoperative period than primary SA patients. Orthopedic surgeons should be aware that revision SA patients have higher opioid dependence rates and require more opioids which may indicate the need for additional consideration for risk assessments, education, and interventions when performing revision SA surgery. III

The incidence of shoulder arthroplasty: rise and future projections compared with hip and knee arthroplasty

There remains a paucity of epidemiologic data from recent years on the incidence of shoulder arthroplasty. We aimed to examine the recent trends and predict future projections of hemiarthroplasty (HA), anatomic (aTSA), and reverse shoulder arthroplasty (RSA), as well as compare these predictions to those for total hip (THA) and knee arthroplasty (TKA). The National Inpatient Sample was queried from 2011 to 2017 for HA, aTSA, and RSA, as well as TKA and THA. Linear and Poisson regression was performed to project annual procedural incidence and volume to the year2025. Between 2011 and 2017, the number of primary shoulder arthroplasties increased by 103.7%. In particular, RSA increased by 191.3%, with 63,845 RSAs performed in 2017. All projection models demonstrated significant increases in shoulder arthroplasty volume and incidence from 2017 to 2025. By 2025, the linear model predicts that shoulder arthroplasty volume will increase by 67.2% to 174,810 procedures whereas the Poisson model predicts a 235.2% increase, to 350,558 procedures by 2025. These growth rate projections outpace those of THA and TKA. The number of shoulder arthroplasties has been increasing in recent years, largely because of the exponential increases in RSA. The overall incidence is increasing at a greater rate than TKA or THA, with projections continuing to rise over the next decade. These data and projections can be used by policy makers and hospitals to drive initiatives aimed at meeting these projected future demands.

Optimistic bias: the more you do, the better you think it goes. Survey analysis of reverse shoulder arthroplasty.

ObjectiveEven though heuristics are very helpful, several biases have been described related to their use. The aim of this study is to analyze the influence of surgery volume on the surgeon’s perception of pain improvement in patients after having received a reverse total shoulder arthroplasty.DesignSuccessive independent samples study.SettingShoulder surgeons attending four shoulder meetings.Participants149 Shoulder surgeons were included.InterventionPhysicians were asked to postulate the preoperative and postoperative pain of patients receiving a reverse shoulder arthroplasty and respond by putting a mark on two visual pain scales.Main outcome measuresPain improvement, years of shoulder practice, number of shoulder studies read over 6 months and the number of reverse shoulder arthroplasties performed per year. To compare the answers of the survey-study, a cohort of 95 patients who had undergone reverse shoulder Arthroplasty because of a rotator cuff arthropathy were prospectively followed.ResultsRegarding the pain score before and after surgery, the patient cohort showed a mean improvement of 6.84 points. In terms of the doctors, the more years of surgical practice, led them to have a greater expectation of improvement (p=0.004). Moreover, the greater the number of prostheses they implanted, the greater the expectation of improvement (p=0.0005). It was the same in terms of the number of studies read by them (p=0.001).ConclusionsYears of practice, hospital position and the number of shoulder arthroplasties done per year all favor the surgeon’s perception that their patients obtain a greater pain relief after receiving a shoulder arthroplasty than the real improvement in pain relief the patients experience.

ACR Appropriateness Criteria Imaging After Shoulder Arthroplasty

There has been a rapid increase in the number of shoulder arthroplasties, including partial or complete humeral head resurfacing, hemiarthroplasty, total shoulder arthroplasty, and reverse total shoulder arthroplasty, performed in the United States over the past two decades. Imaging can play an important role in diagnosing the complications that can occur in the setting of these shoulder arthroplasties. This review is divided into two parts. The first part provides a general discussion of various imaging modalities, comprising radiography, CT, MRI, ultrasound, and nuclear medicine, and their role in providing useful, treatment-guiding information. The second part focuses on the most appropriate imaging algorithms for shoulder arthroplasty complications such as aseptic loosening, infection, fracture, rotator cuff tendon tear, and nerve injury.The evidence-based ACR Appropriateness Criteria guidelines offered in this report were reached via an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) for rating the appropriateness of imaging and treatment procedures for specific clinical scenarios. Further analysis and review of the guidelines were performed by a multidisciplinary expert panel. In those instances in which there was insufficient or equivocal data for recommending the appropriate imaging algorithm, expert opinion may have supplemented the available evidence.

CORR Insights®: What Are Risk Factors for 30-day Morbidity and Transfusion in Total Shoulder Arthroplasty? A Review of 1922 Cases

Where Are We Now? Shoulder arthroplasty still needs a well-defined, accurate complication profile that can be discussed with our patients. The lack of such a profile is mainly due to the limited amount of shoulder arthroplasties done per year relative to the numbers of hip and knee arthroplasties and the limited numbers of outcomes studies. The current study by Anthony and colleagues is a great addition to the literature and is perhaps the largest series of patients studied looking at risk factors and complications. The authors found an 8% risk of short-term morbidity, with risk of transfusion and urinary tract infections topping the list of complications. Operative time greater than 2 hours, preoperative hematocrit less than 38, preoperative steroid use, and patients with congestive heart failure increase the risk of complications. Interestingly, morbid obesity did not affect the complication profile in this cohort of patients studied. With increased attention being focused on costs and outcomes, and with our reimbursement being closely tied to these values, we need more and better information about risk factors. Where Do We Need To Go? Shoulder arthroplasty has made great strides in recent years. The advent of anatomic shoulder systems, patient-specific technology, and reverse shoulder arthroplasty have greatly improved patient satisfaction and outcomes. With this improved technology, many more orthopaedists are performing shoulder replacement surgery. Therefore, it is imperative that we focus our energy on defining the actual risks of each type of shoulder replacement surgery to include primary, revision, reverse, and shoulder arthroplasty in the face of bone loss. Some important questions to definitively answer have been examined in this paper. Who should be performing shoulder arthroplasty? The authors define operative time greater than 2 hours as a risk for complication. Which patients will fare best undergoing this procedure? This paper outlines risk factors associated which increases complications. Does BMI, heart disease, diabetes, smoking, steroid use lead to unacceptable morbidity? What is the risk of DVT in upper extremity surgery? Does it warrant anticoagulation and if so, how aggressive should we be? What is the actual risk of bleeding for each type of shoulder arthroplasty? At what point should we recommend measures to mitigate the risk of transfusion such as preoperative blood donation or the use of transexamic acid? Is shoulder arthroplasty a viable candidate for outpatient surgery as seems to be the current trend in knee arthroplasty? How can we decrease the cost of this procedure while not compromising patient safety and outcomes? How Do We Get There? Without the benefit of databases, joint registries, and outcomes measures, those questions will remain unanswered. As more shoulder arthroplasties are performed, there will be a greater opportunity to define the risk and complication profile. In particular, we need to discern between anatomic total shoulder arthroplasty and reverse shoulder arthroplasty when looking at outcomes. In those databases that collect data by CPT code, this is not possible. A database that can scrutinize each type of shoulder replacement (hemiarthroplasty, total shoulder arthroplasty, reverse total shoulder arthroplasty, revision to total, revision to reverse) would help us define the complications associated with each procedure. The participation of all surgeons who perform shoulder arthroplasties in joint registries would provide many more data points. In these registries, in addition to the procedure performed, it would be beneficial to collect data on the specifics of each procedure to include operative time, implant used, intraoperative blood loss, and intraoperative complications. Patient data to include preoperative comorbidities such as smoking, medical problems, BMI, preoperative hematocrit, age, sex to name a few. Surgeon data such as years in practice, fellowship training, number of shoulder arthroplasties done per year, hospital size, and location should be included. Finally, outcomes measures to evaluate objective and subjective results of the shoulder replacement should be collected. Once consistent measurements have been obtained, developing centers of excellence to address and mitigate potential risks and complications would standardize protocols, increase safely, minimize costs, and ultimately, improve outcomes.

Reverse shoulder arthroplasty in revision of failed shoulder arthroplasty—outcome and follow-up

The number of shoulder arthroplasties has increased over the last decade, which can partly be explained by the increasing use of the reverse total shoulder arthroplasty technique. However, the options for revision surgery after primary arthroplasty are limited in cases of irreparable rotator cuff deficiency, and tuberosity malunion, nonunion, or resorption. Often, conversion to a reverse design is the only suitable solution. We analysed the functional outcome, complication rate and patient satisfaction after the revision of primary shoulder arthroplasty using an inverse design. Over a ten-year period 57 patients underwent revision surgery for failed primary shoulder arthroplasty using a reverse design. Of the 57 patients, 50 (mean age, 64.2 years) were available after an average follow-up of 51 months. Clinical evaluation included the Constant Murley Score, the UCLA score, and the Simple Shoulder Test, whereas radiological evaluation included plain radiographs in standard projections. Patients were also requested to rate their subjective satisfaction of the final outcome as excellent, good, satisfied or dissatisfied. Compared to the preoperative status, the overall functional outcome measurements based on standardised outcome shoulder scores improved significantly at follow-up. The overall mean Constant Murley score improved from 18.5 to 49.3 points, the mean UCLA score improved from 7.1 to 21.6 points, and the mean simple shoulder test improved from 1.2 to 5.6 points. The average degree of abduction improved from 40 to 93° (p < 0.0001), and the average degree of anterior flexion improved from 47 to 98° (p < 0.0001). The median VAS pain score decreased from 7 to 1. Complications occurred in 12 cases (24 %).A total of 32 (64 %) patients rated their result as good or excellent, six (12 %) as satisfactory and 12 (24 %) as dissatisfied. In revision shoulder arthroplasty after failed primary shoulder arthroplasty an inverse design can improve the functional outcome, and patient satisfaction is usually high. However, the complication rate of this procedure is also high, and patient selection and other treatment options should be carefully considered.

Increasing Incidence of Shoulder Arthroplasty in the United States

The number of total shoulder arthroplasties performed in the United States increased slightly between 1990 and 2000. However, the incidence of shoulder arthroplasty in recent years has not been well described. The purpose of the present study was to examine recent trends in shoulder hemiarthroplasty and total shoulder arthroplasty along with the common reasons for these surgical procedures in the United States. We modeled the incidence of shoulder arthroplasty from 1993 to 2008 with use of the Nationwide Inpatient Sample. On the basis of hemiarthroplasty and total shoulder arthroplasty cases that were identified with use of surgical procedure codes, we conducted a design-based analysis to calculate national estimates. While the annual number of hemiarthroplasties grew steadily, the number of total shoulder arthroplasties showed a discontinuous jump (p < 0.01) in 2004 and increased with a steeper linear slope (p < 0.01) since then. As a result, more total shoulder arthroplasties than hemiarthroplasties have been performed annually since 2006. Approximately 27,000 total shoulder arthroplasties and 20,000 hemiarthroplasties were performed in 2008. More than two-thirds of total shoulder arthroplasties were performed in adults with an age of sixty-five years or more. Osteoarthritis was the primary diagnosis for 43% of hemiarthroplasties and 77% of total shoulder arthroplasties in 2008, with fracture of the humerus as the next most common primary diagnosis leading to hemiarthroplasty. The number of shoulder arthroplasties, particularly total shoulder arthroplasties, is growing faster than ever. The use of reverse total arthroplasty, which was approved by the United States Food and Drug Administration in November 2003, may be part of the reason for the greater increase in the number of total shoulder arthroplasties. A long-term follow-up study is warranted to evaluate total shoulder arthroplasty in terms of patient outcomes, safety, and implant longevity.