Reverse Total Shoulder Arthroplasty Research Articles

Acute tear versus chronic-degenerated rotator cuff pathologies are associated with divergent tendon metabolite profiles

ABSTRACT Purpose/Aim Metabolic disorders are risk factors for rotator cuff injuries, which suggests that the rotator cuff is sensitive to local metabolic fluctuations. However, the link between the metabolic microenvironment and pathologic features of acute tear versus chronic degeneration is currently unknown. The overarching goal of this study was to evaluate alterations in tendon metabolite profiles following acute tear or chronic degeneration of the rotator cuff. We hypothesized that injury types (acute tear vs. chronic degeneration) would result in distinct metabolite profiles relative to clinically unaffected tendon controls. Materials and Methods We utilized untargeted metabolomics to identify pathways that were altered at the time of rotator cuff repair (RCR; acute tear) or reverse total shoulder arthroplasty (rTSA; chronic degeneration) relative to total shoulder arthroplasty controls (TSA; tendon clinically unaffected). Results Acute tears to the rotator cuff were associated with an overall decrease in tendon metabolites. This global decrease was primarily associated with glycolic acid and decreased tricarboxylic acid (TCA) cycle activity. Conversely, chronic tendon specimens from patients undergoing rTSA showed an overall increase in metabolites. Most notably, chronic injury was associated with increased levels of multiple amino acids including alanine, aspartate, lysine, and proline. Conclusions Overall, this study demonstrates that distinct metabolite profiles are associated with injury types, and that therapeutic strategies should address both cellular and matrix components regardless of injury induction. The specific pathways identified paired with validated, established, treatment methods may serve as novel therapeutic targets for patients who suffer from rotator cuff injuries.

Uncemented reverse total shoulder arthroplasty: is it a safe option for elderly patients with proximal humerus fractures?

Reverse shoulder arthroplasty (RSA) is a common surgical procedure for elderly patients with proximal humerus fractures. Cement fixation of the humeral stem is considered the gold standard for this procedure. Due to the high prevalence of osteoporosis in this patient population, the risk of intraoperative fractures is increased when uncemented stems are used. Stem loosening is another concern of uncemented stems. However, the use of cement is associated with the risk of cement embolisation, impairment of tuberosity healing, and technical difficulties for later revisions. This study aimed (i) to evaluate the clinical and radiological outcomes of patients treated with uncemented RSA for proximal humerus fractures at two years postoperatively, and (ii) to compare these outcomes between patients with and without decreased low bone quality as measured by the deltoid tuberosity index. The single-centre prospective study included 54 shoulders (52 patients) with a proximal humerus fracture between 2019 and 2022. Enrolled were patients aged 65 and older with acute or secondary displaced three- or four-part fractures or head-split fractures treated with RSA using the same uncemented system and tubercula refixation. At 24 months post-surgery, clinical evaluations included range of motion (ROM), Constant-Murley Score (CS), Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons (ASES) Score. Radiological assessments evaluated scapular notching, radiolucent lines, and greater tuberosity healing. The mean age was 79 years (± 8), 87% were female, and 69% had osteoporotic fractures. At the two-year follow-up, the median SSV was 90% (IQR 80-95), the median CS Score was 76.5 (IQR 72-81), and the median ASES Score was 89.9 (IQR 82-93). The ROM measurements were: median active forward flexion 140° (IQR 120-160), median external rotation 30° (IQR 20-40), and median active internal rotation 6 (IQR 4-8). The greater tuberosity healing rate was 94.5%. Although osteoporotic fractures occurred more often in older patients (mean 81 vs. 72 years, respectively), no other significant differences were detected between the groups. One case of aseptic stem loosening occurred in the non-osteoporotic group. Even in osteoporotic proximal humerus fractures, cementless stems combined with tubercula refixation resulted in favourable outcomes and were not associated with increased complications.

Clinical Outcome and Quality of Life after Modular Reverse Total Shoulder Arthroplasty in Comparison with Joint-Preserving Locking Plate Osteosynthesis in Aged Patients: A Retrospective Comparison Study.

Proximal humeral fractures (PHFs) show a high incidence in aged patients. While nondisplaced fractures achieve good results by conservative treatment, surgical procedures are discussed controversially. Next to open reduction and internal fixation (ORIF), the primary use of reverse shoulder arthroplasty (RSA) has become increasingly important. The aim of this study was to investigate the clinical function, activities of daily living (ADL), as well as pain assessment in patients with PHFs, treated by ORIF or RSA. A retrospective comparison study was assessed. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF or RSA of the proximal humerus, were included in this study. Pain was measured by numeric rating scale (NRS). ADL were obtained by Katz-Index and SF-12. Moreover, shoulder function was assessed using the Oxford Shoulder Score (OSS). The maximum range of motion (ROM) was also recorded. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF (Figure or RSA of the proximal humerus) were included in this study. For statistical analyses, Student's t-test, Wilcoxon test, and Chi-Quadrat test were used. Statistical significance was indicated with p < 0.05. Totally 34 patients with an average age of 76.6 years were included. Surgical treatment was performed on average 5.2 days after diagnosis, differing significantly between the two groups (RSA/ORIF: 6.9/3.5 days) The operation time of RSA (97 min) was significantly longer than for ORIF (78 min). Pain assessment, as well as the Katz-Index and the SF-12, showed no significant differences. Moreover, clinical shoulder function showed no significant discrepancies between the two surgical techniques. Aged patients with PHFs treated with RSA display similar results regarding clinical function, ADL as well as pain perception compared with ORIF. However, revision surgery rate was lower in patients who underwent RSA. Thus, the surgical treatment of PHFs by RSA represents an excellent alternative, especially with regard to an aging patient population.

Reverse Total Shoulder Arthroplasty for Acute Proximal Humerus Fractures: Is Delay Associated With an Increased Rate of Reoperation?

To compare reoperation rates of acute versus delayed reverse total shoulder arthroplasty (RTSA) following a period of nonoperative treatment for proximal humerus fractures (PHFs). We also aimed to identify an optimal time interval from PHF to RTSA before the risk of reoperation significantly increased. . Database review. Ontario, Canada. Adults aged 50 years and older who sustained a PHF (OTA/AO 11A-C) between 2004 and 2019 were included. Exclusion criteria included polytrauma, open fractures, non-Ontario residents, invalid health insurance, and any operative treatment before RTSA. The primary outcome measure was reoperation within 2 years following RTSA. A risk-adjusted, restricted cubic spline was used to model the probability of reoperation according to the time elapsed between PHF and RTSA to identify a time point at which the risk of reoperation significantly increased. A multivariate logistics regression was used to identify predictors. In total, 891 patients (685 acute, 206 delayed) underwent RTSA for PHF. The acute cohort had a significantly lower reoperation rate (3.9%) compared with the delayed cohort (8.3%) (P = 0.02). The odds of reoperation increased with a delay to RTSA greater than 28 days and continued to rise until 100 days after fracture. Patients who underwent RTSA 28 days after PHF were found to have a significantly higher odds of reoperation by 2 years (P = 0.03). Among patients undergoing RTSA for acute PHFs, a delay to surgery greater than 28 days is associated with a greater odds of reoperation and may be useful when counseling patients. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Rehabilitation after reverse total shoulder arthroplasty: a survey of members of the American Shoulder and Elbow Surgeons

Surgeons disagree about whether patients should undertake home physical therapy (HPT) or formal physical therapy (FPT) after undergoing reverse total shoulder arthroplasty (RTSA). Recent studies suggest that HPT is as effective as FPT, but surgeons who perform RTSA may believe that FPT continues to have a role. Our primary purpose was to describe the opinions and self-reported practices of surgeons who perform RTSA regarding prescribing physical therapy (PT) after surgery. We also sought to identify factors associated with prescription of FPT. A survey was distributed electronically from May to September 2023 to the 1076 members of the American Shoulder and Elbow Surgeons who were practicing in the United States at that time. Of these surgeons, 237 (22%) responded to the survey. Anonymous responses were collected via Qualtrics, including demographic data and information about the RTSA implant systems used. Descriptive statistics were used to analyze surgeon characteristics, implant types, and rehabilitation practices. Multivariate logistic regression was used to identify surgeon, procedure, and implant characteristics associated with the likelihood of FPT prescription. Because some respondents reported using multiple RTSA implant types and some did not answer implant-specific questions, a total of 225 RTSA implant types were included. Forty-six percent of respondents reported that they recommended FPT for every patient; 64% said they typically prescribe FPT. A smaller proportion of respondents who had completed a hand and upper-extremity fellowship said that they prescribed FPT compared with those who had not completed such a fellowship. However, PT prescription was not associated with any other studied characteristics, such as number of years in practice or whether the surgeon tended to repair the subscapularis. On average, respondents estimated that 92% of their patients received either FPT or HPT. Respondents also reported varying timeframes for starting PT activities after surgery. For example, 50% of respondents reported recommending passive shoulder range of motion below the shoulder level within the first postoperative week, whereas 73% recommended waiting 2-6 weeks for active shoulder range of motion below shoulder level. Most surveyed surgeons prescribe FPT and/or HPT after primary RTSA, with a slight preference for FPT. Surgical factors did not influence rehabilitation preferences. Further randomized studies to investigate the impact of PT on clinical outcomes of RTSA are needed.

Patients posture affects clinical outcomes and range of motion after reverse total shoulder arthroplasty: A clinical study

BackgroundMovement limitations following implantation of reverse total shoulder arthroplasty (RTSA) have been observed in some patients postoperatively, with implant design and positioning recognized as important influential factors. Recent analyses have identified patient’s posture, measured as scapula internal rotation on computed tomography (CT), as an additional factor influencing the functional outcome after RTSA. However, no clinical study has correlated the preoperatively photo documented posture to functional outcome. It was the aim of this study to correlate preoperatively photo documented posture to scapula orientation using CT and analyze the influence on functional outcome following RTSA implantation. MethodsA prospectively enrolled RTSA database was retrospectively reviewed to include a total of 360 patients with a minimum follow-up of 2 years. Patient´s posture was analyzed using standardized preoperative photo and video documentation. The posture was defined following the classification system of Moroder et al as Type A (upright posture, retracted scapulae), type B (intermediate), type C (kyphotic posture with protracted scapulae). Additionally, CT data were used to measure scapula position (internal rotation). Correlation analyses between them were conducted. Postoperative range of motion (ROM) and clinical outcomes (absolute and relative Constant Score (CSa, CSr)) were compared between the different posture types. ResultsAccording to the photo documented posture types, the patients were divided into posture types A (n=59), B (n=253) and C (n=48). Average CSa differed significantly among the groups (69±16 vs 69±14 vs 64±16, p < 0.05) favoring patients with posture types A and B over type C. In terms of ROM, flexion, abduction and internal rotation significantly differed among the groups. Types A and B exhibited better flexion and abduction (flexion 124±26º and 123±23º vs. 113±25º, abduction 140±34º and 137±30º vs 128±34º). Patients with posture type A demonstrated superior internal rotation (CS points: 5.9±2.9 vs 5.0±2.7 vs 4.4±2.8, p < 0.05). External rotation was better for type A compared to type C (A: 33±17° vs B: 30±16° vs C: 28±18°). Correlation analysis of posture classification using photo documentation and CT scan showed poor reliability (r=0.35). ConclusionPatients with clinical posture types A and B exhibited improved ROM values compared to type C postures. Clinical outcome scores were also notably superior in types A and B. However, the measurement of scapula internal rotation on supine CT does not reliably correlate with photo documentation of patient’s posture. Preoperatively, patient’s posture should be considered in RTSA planning because of the potential influence on ROM and clinical outcomes.

Anatomic Total Shoulder Arthroplasty Revised to Reverse Total Shoulder Arthroplasty: Clinical and Radiographic Outcomes Compared to Primary Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty (rTSA) has become the procedure of choice for a failed aTSA. Little data exists regarding outcomes; the few studies published to date have small numbers, short follow-up, and most do not have a control group or use first generation implants. The purpose of this study is to compare the clinical and radiographic outcomes of failed aTSA revised to rTSA to primary rTSA. A prospective multicenter shoulder registry was used to conduct a retrospective review of patients that received a primary rTSA for osteoarthritis and rotator cuff disease and compare them to those that had an aTSA revised to a rTSA using the same implant between 2007 and 2021 with a minimum follow-up of two years. Cohorts were matched 3:1 (primary:revision) by age, gender, body mass index and length of follow-up. Those that underwent revision for humeral fracture, infection, or an unknown reason were excluded. Preoperative and postoperative range of motion (ROM) and patient reported outcome measures (PROMs) were compared. Outcomes included rates of scapular notching, complications, revision, and patient satisfaction. There were 88 aTSA revised to rTSA compared to 264 matched primary rTSA. In both cohorts, the mean age was 68 years, 59% were female, and the mean follow-up was 56 months. The most common reason for revision was rotator cuff tearing (53%), followed by aseptic glenoid loosening (34%), instability (9%), aseptic humeral loosening (6%) and glenoid component dissociation (3%). At latest follow-up, patients in both groups had statistically significant improvements in all outcome scores, exceeding the minimal clinically important difference (MCID) and the substantial clinical benefit (SCB). The revision cohort had significantly less postoperative abduction (P<0.001) and forward elevation (P=0.001) compared to the primary rTSA cohort. All PROMs in the revision cohort were significantly worse than those in the primary rTSA cohort. Patient satisfaction rate in the revision cohort was significantly lower than the primary cohort (P<0.001). Complication (P=0.005) and revision rates (P=0.013) were significantly higher in the revision cohort, while scapular notching was similar. Patients undergoing revision of a failed aTSA to rTSA have worse clinical outcomes compared to those undergoing primary rTSA, including all PROMs, abduction, elevation, pain relief and patient satisfaction, with higher complication and revision rates. While patients in the revision group had significant improvements that exceeded the MCID and SCB, they do not achieve the same outcomes as patients who undergo primary rTSA.

Do Intact Rotator Cuff Tendons And Soft Tissue Tensioning Affect Stress Shielding In Reverse Total Shoulder Arthroplasty?

Do Intact Rotator Cuff Tendons And Soft Tissue Tensioning Affect Stress Shielding In Reverse Total Shoulder Arthroplasty?

SECEC Grammont Award 2024: The critical role of posture adjustment for range of motion simulation in reverse total shoulder arthroplasty preoperative planning.

The objective of this study was to compare simulated range of motion (ROM) for reverse total shoulder arthroplasty (rTSA) with and without adjustment for scapulothoracic orientation in a global reference system. We hypothesized that values for simulated ROM in preoperative planning software with and without adjustment for scapulothoracic orientation would be significantly different. A statistical shape model of the entire humerus and scapula was fitted into ten shoulder CT scans randomly selected from 162 patients who underwent rTSA. Six shoulder surgeons independently planned a rTSA in each model using prototype development software with the ability to adjust for scapulothoracic orientation, the starting position of the humerus, as well as kinematic planes in a global reference system simulating previously described posture types A, B, and C. ROM with and without posture adjustment was calculated and compared in all movement planes. All movement planes showed significant differences when comparing protocols with and without adjustment for posture. The largest mean difference was seen in external rotation, being 62° (SD 16°) without adjustment compared to 25° (SD 9°) with posture adjustment (p < 0.001), with the highest mean difference being 49° (SD 15°) in type C. Mean extension was 57° (SD 18°) without adjustment versus 24° (SD 11°) with adjustment (p < 0.001) and the highest mean difference of 47° (SD 18°) in type C. Mean abducted internal rotation was 69° (SD 11°) without adjustment versus 31° (SD 6°) with posture adjustment (p < 0.001), showing the highest mean difference of 51° (SD 11°) in type C. The present study demonstrates that accounting for scapulothoracic orientation has a significant impact on simulated ROM for rTSA in all motion planes, specifically rendering vastly lower values for external rotation, extension, and high internal rotation. The substantial differences observed in this study warrant a critical re-evaluation of all previously published studies that examined component choice and placement for optimized ROM in rTSA using conventional preoperative planning software.

Influence of preoperative rotational shoulder stiffness on rate of motion restoration after anatomic and reverse total shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff

BackgroundA subset of patients undergoing anatomic and reverse total shoulder arthroplasty (aTSA and rTSA) lag behind their peers in regaining overhead range of motion (ROM) after surgery. The primary purpose of this study was to compare the rate of recovery of ROM after aTSA and rTSA performed in stiff (preoperative passive external rotation [ER] ≤0 °) versus non-stiff (preoperative passive ER >0°) shoulders with RCI-GHOA. HypothesisWe hypothesized that preoperatively stiff shoulders (preoperative passive ER ≤0 °) would have slower recovery in ROM postoperatively with lower postoperative motion compared to non-stiff shoulders. Methods and materialsA retrospective review of a multi-institution shoulder arthroplasty database was performed between 2001 and 2021. We identified 1,164 aTSAs and 539 rTSAs performed for RCI-GHOA with a minimum of 2-year clinical follow-up along with follow-up between 3–6 months and a third visit at any other time point. Primarily, the rate of recovery in ROM and time to maximum ROM was evaluated. Secondarily, we assessed six outcome scores and the influence of subscapularis repair during rTSA. Recovery in each outcome was modeled using continuous two-phase segmented linear regression models with random effects. Rate of recovery was defined as the slope of the first segment. Patients were considered to have recovered after surgery at the timepoint corresponding to the inflection point between piecewise segments. ResultsOf the 1,164 aTSAs and 539 rTSAs included, 172 aTSAs (15%) and 80 rTSAs (15%) were stiff preoperatively, respectively. Compared to preoperatively stiff aTSAs, non-stiff aTSAs regained ER, abduction, internal rotation (IR), and forward elevation (FE) faster over a shorter duration. Similarly, non-stiff rTSAs regained ER, abduction, and FE faster and over a shorter duration compared to stiff rTSAs, but regained IR more slowly over a longer duration. Stiff rTSAs performed with subscapularis repair did not have any appreciable gain in ER after the immediate postoperative period. Although non-stiff and stiff rTSAs performed without subscapularis repair regained ER at a similar rate (4.4 vs. 4.2 °/month), stiff rTSAs continued to regain ER 1.9-times longer (11.9 vs. 6.4 months). When the subscapularis was repaired, non-stiff rTSAs regained abduction and IR faster over a short duration compared to stiff rTSAs. ConclusionsPreoperative stiffness is associated with slower recovery of active ROM over a longer duration in patients undergoing shoulder arthroplasty for RCI-GHOA. Level of evidenceIII; Retrospective Cohort Comparison; Treatment Study.

Comparing the Exactech Equinoxe Reverse TSA for Fracture versus Degenerative Conditions: Five-Year Minimum Follow-Up

Reverse total shoulder arthroplasty (rTSA) has become the operative treatment of choice for acute proximal humerus fractures in the elderly population, but little data exists on the long-term outcomes or how they compare to rTSA done for degenerative conditions. The purpose of this study is to compare the clinical and radiographic outcomes of patients undergoing rTSA for acute fracture versus degenerative conditions with a minimum 5-year follow-up. Data was extracted from an international registry of patients with the Exactech Equinoxe rTSA implant from 2007-2018. Patients with a minimum follow-up of 5 years were then split into fracture and degenerative cohorts and matched 1:3 based on age, sex, and follow-up duration. Clinical and radiographic outcomes were compared between the cohorts including range of motion (ROM), patient-reported outcome measures (PROM), VAS pain score, complication and revision rates, implant characteristics, and scapular notching. This data was analyzed using Welch's t-test, Fisher's exact test, or Wilcoxon rank sum test. There were 384 total patients included in the study, with 96 fractures and 288 degenerative. At a mean follow-up of 6.4 years, the degenerative cohort had significant improvements in all PROMs and ROM, compared to their preoperative status. At the latest follow-up, the mean ASES score was 83 and the mean VAS pain score was 1.1 for both cohorts. Patients with degenerative indications had greater forward elevation which did not meet the minimally clinically important difference and greater internal rotation which did not meet the substantial clinical benefit threshold. Patient satisfaction was very high for both cohorts, with 97% in the degenerative cohort and 91% in the fracture cohort satisfied with the procedure (p=0.276). Complication and revision rates were similar between the two cohorts. Patients in the fracture cohort had a larger glenosphere diameter (p=0.045) and greater combined liner/tray offset (p=0.05). Patients in the elective cohort more frequently required an augmented baseplate (p<0.001). Scapular notching was 11% in the degenerative cohort and 9% in the fracture cohort (p=0.82). This study demonstrates no significant differences in the clinical or radiographic outcomes at a minimum of 5 years follow-up for patients undergoing rTSA for acute fracture versus degenerative conditions. Patients undergoing rTSA for either indication have similar rates of complications, revisions, and scapular notching, with high patient satisfaction. Patients undergoing rTSA for an acute fracture can expect similar results to those undergoing rTSA for degenerative conditions at minimum 5-year follow-up.

Assessing proximal humerus cortical bone thickness for total shoulder arthroplasty: A cadaveric study

BackgroundIn reverse total shoulder arthroplasty, a humeral osteotomy is typically performed at the anatomic neck. The quality and quantity of cancellous and cortical bone impacts sizing of implants. Little-to-no information exists characterizing the transition of this bone quality at this location. This cadaveric study focused on measuring and analyzing the transition zone of the proximal humerus bone quality to better understand the implications of utilizing different implant sizes during reverse total shoulder arthroplasty. This assessment was conducted through the usage of a newly designed indentation depth probe. MethodsAn Exactech, Inc. designed indentation depth probe was used to assess the transition from cancellous to cortical bone in 45 cadavers after a humeral osteotomy was performed. The thickness of the cortical rim was measured in regard to superior, inferior, anterior, and posterior quadrants. Linear regressions were utilized to evaluate the relationship between anatomic location in regard to cortical bone thickness. Independent sample two-tailed t-tests were also conducted to examine the relationship between spring force and bone thickness. Finally, independent sample two-tailed t-tests or Mann-Whitney U tests were utilized to examine the relationship between cortical thickness and variables including sex, age, osteoporosis, and a diagnosis of cancer. ResultsAll linear regressions were found to be insignificant excluding the relationships between inferior to anterior (p=0.003) and inferior to posterior (p=0.001). All t-tests and Mann-Whitney U tests were found to be insignificant, except for the relationship between age and the posterior aspect (p=0.04). ConclusionsIn our cohort, cortical bone thickness was not impacted by sex, diagnosis of osteoporosis, or diagnosis of cancer. Interestingly, age was found to only have an impact on the posterior aspect of the cortical bone rim. Differences in cortical bone thickness were also found in regard to both the inferior to anterior and inferior to posterior comparisons. Clinical RelevanceThis suggests that differences in cortical bone thickness can occur, and that one point of assessment might not be sufficient.

Concordance Of Three Different Methods To Obtain Samples For Culture In Reverse Total Shoulder Arthroplasty. A Prospective Study

Concordance Of Three Different Methods To Obtain Samples For Culture In Reverse Total Shoulder Arthroplasty. A Prospective Study

Patients Posture Effects Clinical Outcomes And Range Of Movement In Patients After Reverse Total Shoulder Arthroplasty: A Clinical Study

Patients Posture Effects Clinical Outcomes And Range Of Movement In Patients After Reverse Total Shoulder Arthroplasty: A Clinical Study

Incidence of Shoulder Prosthetic Joint Infection Throughout the COVID-19 Pandemic

Introduction1-2% of patients who undergo anatomic and reverse total shoulder arthroplasty are diagnosed with a prosthetic joint infection which requires revision surgery, prolonged recovery and rehabilitation, and antibiotic treatment. During the COVID-19 pandemic, anecdotal evidence suggested an increased rate of PJI among all patient populations. However, there have been no studies characterizing PJI incidence following shoulder arthroplasty during the COVID-19 pandemic. In the present study, we sought to evaluate the incidence of shoulder PJI during the COVID-19 pandemic. Materials & MethodsPatients undergoing revision shoulder arthroplasty for PJI at an academic medical center between 2017-2021 were identified: patients before COVID-19 (2017-2019) and patients during COVID-19 (2020-2021). Patient demographics, laboratory data, history of COVID-19 infection and vaccination, antibiotic treatment, and final surgical treatment were collected. Patient-reported outcome measures (PROMs) (ASES, SANE, SAS, PROMIS (Physical Function, Pain Intensity, Upper Extremity, Global 10), and VR/SF12) were collected. PJI incidence was calculated from a retrospective chart review which identified patients with PJI as defined by the International Consensus meeting (ICM) on Musculoskeletal Infection in 2018 and who underwent revision surgery and antibiotic treatment. Incidence rate analysis and independent t-tests were conducted to compare mean baseline PROMs. Descriptive analysis of the collected data included means and standard deviations for continuous variables and frequencies and percentages for discrete variables. Statistical significance was set at a p-value < 0.05. Results46 patients were identified with 20 patients undergoing a revision surgery for a PJI during the pre-COVID-19 time interval and 26 during the COVID-19 time interval. 20% underwent single stage revision (4 pre-COVID-19 and 5 during COVID-19), 50% underwent two stage revision (10 pre-COVID-19 and 13 during COVID-19), and 30% underwent a DAIR procedure (6 pre-COVID-19 and 8 during COVID-19). There was a significant increase in shoulder PJI infections between the pre-COVID-19 time interval and during COVID-19, with PJI incidence rates of 1.1% and 2.1%, respectively (p = .028). There was no significant difference in any outcome scores, microbes on aspiration, inflammatory markers, or duration of treatment between the two time intervals. ConclusionWhile this study does not show clear evidence to an underlying mechanism explaining the increased PJI incidence observed during the COVID-19 pandemic, this study does show a significant increase in the rate of shoulder PJI status post shoulder arthroplasty during COVID-19. Further investigation into how the vaccine and COVID-19 infection may affect the body’s immune system may provide insight into this increase.

Tranexamic Acid Use in Total Shoulder Arthroplasty Continues to Increase and is Safe in High-Risk Patients

IntroductionTranexamic acid (TXA) is increasingly utilized in total shoulder arthroplasty (TSA) to minimize blood loss. Despite its benefits, concerns persist regarding its use in patients at elevated risk of postoperative venous thromboembolism (VTE). This study evaluates trends in TXA use and assesses its safety in both general and high-risk patient populations. MethodsPatients who underwent primary, elective anatomic TSA and reverse TSA from January 1st, 2016, to December 31st, 2020, were identified using the Premier database. TXA use trends and the proportion of patients requiring blood transfusions were reported. Patients were divided on the basis of having received TXA on the day of surgery or not. To account for confounding variables, a propensity score was generated for the probability of treatment with TXA. A sub analysis of high-risk patients, defined as those with a history of VTE, was performed using multivariable regression analyses. Endpoints included the 90-day risk of pulmonary embolism (PE), deep vein thrombosis (DVT), and transfusion. ResultsIn total, 86,356 patients underwent TSA from 2016 to 2020. Of these, 41,380 (47.9%) received TXA, and 44,976 (52.1%) did not. After matching, 28,232 received TXA, and 28,232 did not. The use of TXA increased from 33.4% in 2016 to 60.3% in 2020. The rates of transfusion decreased from 1.05% to 0.47%. Following matching, the risk of all thromboembolic complications (odds ratio [OR]: 0.98, 95%-Confidence Interval [CI]: 0.72-1.33, p=0.874), DVT (OR: 1.11, 95%-CI: 0.71-1.71, p=0.655), and PE (OR: 0.87, 95%-CI: 0.56-1.33, p=0.513) were similar between cohorts. The high-risk cohort comprised 4,757 patients with a history of VTE, of which 1,850 (38.9%) received TXA, and 2,907 (61.1%) did not. The use of TXA for high-risk patients increased from 27.4% to 52.0% while rates of transfusion decreased from 1.76% to 0.70%. Following multivariable regression, there was similar risk of all thromboembolic complications (adjusted OR [aOR]: 0.77, 95%-CI: 0.47-1.28, p=0.316), DVT (aOR: 0.96, 95%-CI: 0.39-2.36, p=0.92), and PE (aOR: 0.54, 95%-CI: 0.23-1.28, p=0.163) between high-risk cohorts. DiscussionTXA in shoulder arthroplasty usage has nearly doubled from 2016 to 2020 and is now administered to 60% of all patients. This rise in TXA use has been coupled with a significant decrease in the risk of blood transfusion. Patients receiving TXA were not at increased risk of thromboembolic, infectious, epileptogenic, surgical, and medical complications even if they had a history of VTE.

Glucagon-like Peptide-1 Receptor Agonist Use is Associated With Increased Risk of Perioperative Complication and Readmission Following Shoulder Arthroplasty

Glucagon-like peptide-1 (GLP-1) receptor agonists, increasingly used for diabetes management and weight loss, have been linked to lower readmission rates after knee and hip arthroplasty. However, their impact on total shoulder arthroplasty (TSA) outcomes remains unclear. This study investigates the effects of GLP-1 receptor agonists on major complications and revisions following TSA. A retrospective query of the TriNetX database from 2010 to 2023 was performed to identify patients who underwent anatomic or reverse TSA and were prescribed GLP-1 receptor agonists. GLP-1 receptor agonist users were 1:1 propensity score-matched to controls for demographic factors and comorbidities, yielding 1,259 patients in each group. Outcomes included 90-day postoperative medical complications and readmission and revision surgery at 2 years. Odds ratios (ORs), 95% confidence intervals, and P values were calculated. After Bonferroni correction, P < 0.005 was considered significant. GLP-1 receptor agonist users (n = 1,259) experienced significantly higher rates of deep vein thrombosis (1.6% vs. 0.9%; OR 3.0; P = 0.001), myocardial infarction (1.60% vs. 0.9%; OR 2.84; P = 0.003), pneumonia (3.34% vs 1.50%; OR 2.25; P = 0.003), transfusion (7.1% vs. 4.3%; OR 1.7; P = 0.003), and readmission (8.1% vs 5.2%; OR 1.6; P = 0.004) in the 90-day postoperative period compared to patients not taking GLP-1 receptor agonists. There were no differences in the rates of stroke, pulmonary embolism, postoperative anemia, or renal failure. In patients with a minimum 2-year follow-up (n = 776), there was no difference in revision rate (3.2% vs 1.8%; OR 1.8; P = 0.07). GLP-1 receptor agonist use during TSA was associated with an increased risk of deep vein thrombosis, myocardial infarction, pneumonia, need for transfusion, and readmission. Further investigation into the perioperative risk assessment and medical optimization of patients utilizing GLP-1 receptor agonists may be warranted.

Short-Term Clinical Results of Middle Trapezius Tendon Transfer with Achilles Tendon Allograft for Irreparable Supraspinatus Tears

BackgroundAmong emerging options, Middle Trapezius Tendon (MTT) transfer has shown promise, particularly in isolated supraspinatus irreparable rotator cuff tears (ISIRCTs) and nonarthritic shoulders unsuitable for reverse total shoulder arthroplasty. This study aims to assess clinical and radiological results of MTT transfer utilizing an Achilles tendon allograft for ISIRCTs. MethodsWe retrospectively reviewed patients who received MTT transfer using Achilles tendon allograft for ISIRCTs between May 2020 and August 2021. Clinical assessments using pain VAS, Constant, ASES, UCLA, and SANE score were assessed pre- and postoperatively. Active Range of Motion (aROM) were obtained, and radiologic assessments included AHD, Hamada grade, and MTT integrity. Results18 patients were involved with mean age of 63.8 ± 7.1, followed for an average of 25.4 ± 4.4 months. Significant improvements were observed in pain relief (VAS:4.7±1.5 to 1.6±0.9, P<.001), shoulder function (Constant: 53.1±11.1 to 70.0±15.1, ASES: 57.7±13.5 to 78.2±17.0, UCLA: 13.6±4.5 to 22.0±6.4; all P<.001), and patient satisfaction (SANE: 51.3±14.1 to 73.7±15.0, P<.001). Active range of motion significantly improved in Forward elevation (FE) and abduction (ABD). Radiologic assessments showed no significant change in AHD and Hamada grade, with p-values of 0.503 and 0.260, respectively. ConclusionMTT transfer using Achilles tendon allograft showed improvement in pain relief, clinical scores, and active FE and ABD in patients with ISIRCTs. However, the validation of its effectiveness necessitates multicenter and long-term studies.

Smokeless Tobacco Use is Associated with a Lower Risk of Perioperative Complications and Revision Surgery after Anatomic and Reverse Total Shoulder Arthroplasty Compared to Cigarette Smokers

Smokeless Tobacco Use is Associated with a Lower Risk of Perioperative Complications and Revision Surgery after Anatomic and Reverse Total Shoulder Arthroplasty Compared to Cigarette Smokers

The Critical Role Of Posture Adjustment For Range Of Motion Simulation In Reverse Total Shoulder Arthroplasty Preoperative Planning

The Critical Role Of Posture Adjustment For Range Of Motion Simulation In Reverse Total Shoulder Arthroplasty Preoperative Planning