An analysis of variability and terminology inconsistencies in the amount and type of constraint in polyethylene bearing liners across reverse shoulder arthroplasty implant systems.

Impact of reverse total shoulder arthroplasty on scapulohumeral rhythm: a systematic review and meta-analysis.

Muscle activation variability in relation to functional internal rotation in reverse total shoulder arthroplasty.

Rotator cuff repair vs. reverse arthroplasty for massive tears: A patient-centered outcome analysis.

Patients with complex anatomy and osseous deformity undergoing primary and revision total shoulder arthroplasty can pose challenges to surgeons and render off-the-shelf implants insufficient. The advent of three-dimensional printing has enabled the emergence of patient-specific instrumentation and custom implants which offer tailored solutions to address each patient's unique anatomy. This article examines the principles, indications, and clinical outcomes of patient-specific instrumentation and custom implants in total shoulder arthroplasty.

Acromial and scapular spine fractures following reverse total shoulder arthroplasty (rTSA) occur with prevalence rates ranging from 0.8% to 7.2%.1-5 This study aimed to identify radiographic risk factors for the development of scapular stress fractures following primary rTSA and to provide quantifiable recommendations for surgeons to decrease risk for stress fracture. This was an institutional review board‑approved retrospective case-control study. Electronic medical records were screened for patients who underwent a rTSA from 2010 to 2021. Patients with stress fractures were then matched in a 3:1 ratio for a comparison control group. Radiographs were analyzed and compared at multiple time points. Patients developed a fracture at a median of 3.4 months postoperatively (n = 14, mean age = 76 years, 79% female) and were compared with matched controls who did not (n = 42, mean age = 76 years, 79% female). Minimal radiographical differences were seen except in those who developed a fracture of lower Hamada classification (1 to 3 vs. 4 to 5) preoperatively (P = 0.005) and wider acromion to lateral humerus distance postoperatively (P = 0.034). Regarding pre- to postoperative change, the fracture group had an increase in acromion to lateral humerus distance by 2.3 mm, whereas the control group had a reduction by 3 mm (P = 0.024). These two variables alone were 80.4% accurate in predicting fractures on logistic regression. For the acromion to lateral humerus distance, receiver operator characteristic analysis identified 9.78 mm as the most discriminant cutoff (area under curve = 0.690). In our study, the distance from the lateral edge of the acromion to the lateral humerus was a useful tool for identifying risk of acromial fracture. Based on these findings, our current practice is to avoid lateralizing beyond an acromion to lateral humerus distance of 10 mm and to use unicortical screw fixation in the superior half of the glenoid to avoid creation of a stress riser in the scapular spine. III.

Serotonergic antidepressants are associated with increased bleeding events within 30-days after total shoulder arthroplasty: a propensity-matched analysis of 54,291 patients.

Short- to midterm outcomes following anatomic total shoulder arthroplasty (aTSA) are well documented. However, few studies to date have reported on long-term outcomes following aTSA. The purpose of this study was to investigate and report the long-term clinical, functional, and radiographic outcomes of patients who underwent anatomic aTSA at our institution. Patients who underwent aTSA with a minimum of 10.0 years of follow-up were included. Range of motion (ROM; forward elevation, external rotation, internal rotation), patient-reported outcomes (American Shoulder and Elbow Surgeons score, simple shoulder test, and visual analog scale scores), and radiographic variables (glenoid morphology, lateral humeral offset, acromiohumeral interval, and humeral lucency) were recorded. Implant failure-free survival was defined as shoulders requiring no revision surgeries following primary aTSA. Seventy-eight patients (78 shoulders) were included with an average age at surgery of 63.2 ± 8.4 years and a mean follow-up of 15.0 ± 4.5 years. All measurements of ROM saw notable preoperative to postoperative improvements. Overall, forward elevation improved from 118.8° ± 23.9° preoperatively to 147.6° ± 22.6° postoperatively (P < 0.01). External rotation improved from 22.3° ± 25.8° to 54.7° ± 18.6° (P < 0.01); internal rotation improved from L4 to T12 (P < 0.01). American Shoulder and Elbow Surgeons scores improved from 34.8 ± 21.6 preoperatively to 72.6 ± 23.0 postoperatively (P < 0.01). Simple shoulder test scores improved from 3.5 ± 2.6 preoperatively to 8.1 ± 3.4 postoperatively (P < 0.01). Visual analog scale pain scores improved from a mean preoperative score of 6.4 ± 2.7 to a mean postoperative score of 2.3 ± 2.8 (P < 0.01). Implant survivorship was 97% at 10 years and 72% at 20 years. aTSA provides long-term improvements in pain scores, ROM, and shoulder function. Implant survivorship was excellent and demonstrated aTSA results to be durable at 20 years postoperatively. IV.

Conversion to hemiarthroplasty is occasionally performed as a salvage option in patients with failed total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) when further revision to RSA is not feasible. This Systematic review and meta-analysis aims to evaluate the functional and clinical outcomes and complication rates of revision to shoulder hemiarthroplasty. A systematic review was conducted according to PRISMA guidelines, with searches performed in PubMed, Embase, and Cochrane databases up to January 2024. Studies reporting functional outcomes, pain scores, range of motion, complication rates, or revision rates following conversion of failed TSA or RSA to hemiarthroplasty, with ≥24 months follow up, were included. Thirteen studies comprising 211 patients met inclusion criteria. Pain scores improved significantly postoperatively (mean difference 2.57 points on a 10-point scale, p < 0.0001). Functional scores increased by a mean of 16.83 points (on a 100-point scale, p = 0.01). Overall patient satisfaction was reported in seven studies, with 58% of patients satisfied. The reoperation rate was 16.1%. Hemiarthroplasty offers a viable salvage option for failed TSA or RSA in patients unsuitable for complex revision surgery. While functional gains are modest and range of motion improvement is limited, pain relief and preservation of bone stock support its role in selected revision scenarios.

Background/Objectives: Arthroscopic rotator cuff repair (ARCR) and reverse shoulder arthroplasty (RSA) are among the most commonly used surgical treatment methods. A growing number of studies assess the changes in the biomechanical and viscoelastic properties of the muscles and tendons surrounding the shoulder joint. Therefore, the aim of this study was to review the literature to determine how the biomechanical properties of the muscles surrounding the shoulder joint change as a result of ARCR and RSA, and whether MyotonPRO was used in this group of patients. Methods: A review of the international scientific literature was conducted in September 2025. The study was based on searches of the following databases: Google Scholar, PubMed, Scopus, and Web of Science. A final total of 32 articles were included in the review. Results: In this article, we have shown that ARCR and RSA procedures cause changes in the biomechanical properties of the muscles surrounding the shoulder joint. We also demonstrated that MyotonPRO has been used in this group of patients in a limited number of studies. However, the studies confirm that it is a reliable tool for examining upper limb muscles. Conclusions: This literature review demonstrates a new direction in research using MyotonPRO. Using this device in muscle testing in patients after ARCR and RSA will allow for a better understanding of the changes that occur in muscles as a result of these procedures, as research in this area is new and incomplete.

ABSTRACT Background Rotator cuff tears cause burdensome pain impacting patients’ daily use of their shoulder. We evaluated the outcomes after rotator cuff repair (RCR) utilizing two different high-tensile sutures. Methods A comparative study using a hospital dataset evaluated a novel high-tensile contractile suture, Dynacord, or a high-tensile non-contractile (NC) suture, FiberWire. The primary outcome was one-year all-cause hospital revisits. Secondary outcomes were shoulder-related hospital revisits and revisions defined as tendon transfer, RCR, or reverse shoulder arthroplasty. Propensity score weighting was applied, and generalized linear models were used to analyze all outcomes. Results The cumulative incidence of one-year all-cause hospital revisits was significantly lower for the novel vs. the NC suture (32.5% vs. 37.0%; p-value: <0.001). The incidence of shoulder-related revisits was 10.6% vs. 13.9% and revision surgery overall was 1.4% vs. 1.4%; and for each revision surgery type, RCR was 1.3% vs. 1.1%, tendon transfer was 0.06% vs. 0.1%, and rTSA was 0.1% vs. 0.4%. Conclusions Compared to the NC suture, use of the novel suture was associated with a significantly lower rate of all-cause hospital revisits within 1 year postoperatively, and a lower shoulder-related revisit rate. However, no difference was observed between groups in the overall revision surgery rate.

Elective shoulder arthroplasty waiting list times are increasing. Day case shoulder arthroplasty (DCSA) could help address this. This study aimed to review the safety, cost savings and patient satisfaction of a DCSA pathway introduced in May 2021. All elective shoulder arthroplasties over three years (May 2021-2024) at a single centre were prospectively collected and retrospectively analysed. Two cohorts were compared: DCSA and inpatient. Primary outcomes were 90-day readmission and complication rates. Secondary outcomes were estimated cost savings and patient satisfaction using a locally developed non-validated questionnaire. Of 102 shoulder arthroplasties, 25 were DCSA and 77 were inpatients. DCSA patients were significantly younger (mean age 64.8 vs. 73.6 years; p < 0.001) and more likely to have ASA I status (16% vs. 6%; odds ratio (OR) 2.74, 95% confidence interval (CI) 0.68-11.14; p = 0.04). There were no significant differences in 90-day complications (4% vs. 9%; OR 0.42, 95% CI 0.05-3.56; p = 0.42) or readmissions (0% vs. 2%; OR 0.42, 95% CI 0.05-3.56; p = 1.00). All DCSA patients reported treatment success and were six times more likely to recommend it. Estimated cost savings were £10,262.75, with £37,766.92 potentially saved if all patients had undergone DCSA. DCSA is safe, cost saving, and has high patient satisfaction. DCSA could be more widely adopted across the UK.

The literature on arthroscopic lysis of adhesions for postoperative stiffness following shoulder arthroplasty is limited, offering insufficient guidance. This systematic review aimed to evaluate the improvement in range of motion following arthroscopic lysis of adhesions for noninfectious stiffness after shoulder arthroplasty. A systematic review was conducted using five databases. The reason for shoulder arthroplasty, type of arthroplasty, time from arthroplasty to arthroscopy, follow-up duration, preoperative and postoperative range of motion, patient-reported outcomes, complications, reintervention or revision, and patient satisfaction were collected. No pooled estimates were calculated due to the heterogeneity of study designs, small sample sizes, and the moderate-to-low methodological quality of the included studies. Four studies, which amounted to 29 patients, published from 2000 to 2024 were included. Preoperative ranges were 20°-120° for forward flexion, 20°-60° for abduction, 0°-60° for external rotation, and hip to L2 for internal rotation. Postoperatively, these improved to 60°-170°, 51°-110°, 0°-80°, and hip to T9, respectively. No complications or reintervention were reported. Patient satisfaction rates ranged from 74% to 100%. Follow-up ranged from 12 to 55 months. Arthroscopic lysis of adhesions appears to be a safe and effective treatment for stiffness following shoulder arthroplasty.

The volume of shoulder arthroplasties in the United Kingdom continues to rise, with 8221 cases recorded in the National Joint Registry (NJR) in 2023. Amid increasing demand and pressure on NHS resources, reducing hospital length of stay (LOS) is a key priority for improving efficiency. This study aimed to identify independent predictors of prolonged LOS following shoulder arthroplasty. NJR data from April 2012 to March 2022 were linked with Hospital Episode Statistics (HES) for England. Prolonged LOS was defined as >2 nights (above the cohort median). Variables analysed included age, sex, Charlson comorbidity index (CCI), comorbidities, surgical indication, implant type, operating surgeon volume, and day of surgery. Univariable and multivariable logistic regression models were used to identify predictors. Among 47,145 patients, older age, higher CCI, and ASA grades 3 and 4 were significantly associated with extended LOS. Male patients had a 45% reduced risk of prolonged stay. Trauma-related procedures and surgeries conducted Friday-Sunday were associated with increased LOS. Patients treated by high-volume surgeons had a 19% lower risk of prolonged LOS. Several comorbidities were independently predictive; however, differed across implants. Both patient-level and system-level factors contribute to prolonged LOS. Optimising perioperative care and scheduling may reduce LOS and improve NHS resource utilisation.

Robotic-assisted reverse shoulder arthroplasty has recently entered early limited clinical use, with the goal of improving the execution of preoperative plans and reducing malposition outliers that increase complication rates and health-care costs. This Innovation article reviews the rationale for this technology, explores its potential impact, examines key implementation challenges, and highlights the future directions needed to determine its ultimate value.

Periprosthetic humeral fractures are becoming an increasingly more relevant complication due to the growing number of shoulder arthroplasties being performed. The management of these fractures is complex and influenced by multiple factors. This article provides astructured overview of current classification systems, discusses therapeutic challenges and outlines contemporary treatment strategies for periprosthetic humeral fractures. Anarrative literature review was conducted focusing on the etiology, classification and treatment options of periprosthetic humeral fractures. Particular attention is given to the classification systems of Wright and Cofield and the classification system of Sanchez-SoteloPF with an emphasis on their relevance to surgical decision making. The management of periprosthetic humeral fractures requires an individualized approach. Nondisplaced fractures with astable implant can be treated conservatively, whereas displaced fractures or those associated with implant loosening typically necessitate surgical intervention. Surgical options include open reduction and internal fixation (ORIF), revision arthroplasty and, in selected cases, the use of custom-made implants. Early mobilization combined with interdisciplinary management is critical to achieving favorable functional outcomes. Periprosthetic humeral fractures continue to represent ademanding complication in shoulder surgery. Acomprehensive understanding of classification systems and modern treatment strategies is essential for accurate treatment planning and improved patient outcomes.

Background: Reverse shoulder arthroplasty (RSA) relies on secure baseplate fixation to the glenoid. This carries a risk of suprascapular nerve (SSN) injury during peripheral screw insertion. Although fixed safe zones have been described, it remains unclear whether these scale with scapular morphometry or whether common screw positions confer differential SSN risk. Methods: Twenty cadaveric shoulders (ten pairs) were dissected. The superior safe zone (distance from the supraglenoid tubercle to SSN at the suprascapular notch) and posterior safe zone (distance from the glenoid rim to SSN at the spinoglenoid notch) were measured. Scapular dimensions (height, spine length, width) were measured. In ten shoulders, simulated RSA baseplate fixation was performed with superior screws placed at 11, 12, or 1 o'clock and posterior screws at 8, 9, or 10 o'clock. Screw lengths were based on glenoid depth. Cortical breach and SSN proximity were recorded. Linear regression assessed relationships between scapular dimensions and safe zones. Results: The superior safe zone (mean 2.9 ± 0.5 cm) significantly correlated with scapular dimensions (r = 0.78-0.86; p < 0.0001). All superior screws remained intraosseous across configurations. The posterior safe zone (1.9 ± 0.6 cm) showed no correlation. Posterior cortical breach occurred in 50% of specimens across all tested positions and was associated with smaller scapular spine length (p = 0.027). No significant difference in SSN proximity was observed between posterior screw positions. Conclusions: Scapular dimensions predict the superior, but not posterior, safe zone. Scapulae with shorter spine lengths demonstrated increased risk of posterior cortical breach, independent of screw position. These findings establish anatomical scalability of the superior safe zone and suggest that scapular morphometry may inform preoperative RSA planning; however, prospective validation is needed before routine clinical implementation.

Anatomic total shoulder arthroplasty (aTSA) has demonstrated excellent outcomes for pain relief, functional restoration, and implant survival in patients with glenohumeral osteoarthritis. While return to sport (RTS) has become an increasingly important measure of surgical success in this population, the role of hand dominance in this context remains poorly understood. To evaluate the impact of hand dominance on RTS after aTSA in patients aged ≤65 years. Cohort study; Level of evidence, 3. Patients aged ≤65 years who underwent primary aTSA for glenohumeral osteoarthritis between 2016 and 2021 were identified using a prospectively maintained institutional registry. All patients were contacted to assess hand dominance, pre- and postoperative sport participation, timing and level of RTS, and satisfaction. Patients were categorized by whether surgery was performed on the dominant or nondominant shoulder. Patients with ambidextrous hand dominance or bilateral surgery were excluded. Univariate and multivariable comparisons were performed. Of 279 eligible patients, 165 (59.1%) reported preoperative sport participation, of which 57.6% (n = 95) underwent dominant-sided aTSA and 42.4% (n = 70) underwent nondominant-sided aTSA. There were no significant differences in baseline characteristics between groups (P > .15 for all). Successful RTS at any level was significantly more common in the nondominant group versus the dominant group (85.7% vs 69.5%; P = .015). Similarly, RTS at the same or higher level of sport was significantly more common in the nondominant versus dominant group (61.4% vs 45.3%; P = .040). American Shoulder and Elbow Surgeons score improvements at a mean follow-up of 2.8 years (SD, 1.7) were not significantly different between the nondominant- and dominant-sided groups (median [IQR], 46.2 [30.5-60.8] vs 37.0 [21.9-59.4]; P = .11). In patients aged ≤65 years, aTSA on the nondominant shoulder was associated with a significantly higher rate of RTS. These findings suggest that hand dominance may be an important and underrecognized factor in RTS outcomes after aTSA in young, active patients.

Risk factors for postoperative anemia and blood transfusion in primary anatomic and reverse total shoulder arthroplasty.

Shoulder arthroplasty in patients with prior Latarjet procedures is technically challenging due to altered anatomy and soft tissue changes. This study aimed to compare clinical outcome measures, complications, and implant survival in primary hemiarthroplasty (HA), anatomic total shoulder arthroplasty (aTSA), and reverse total shoulder arthroplasty (rTSA) in patients with previous Latarjet surgery vs. matched cohorts. A retrospective analysis was conducted including a total of 69 patients, comparing 23 post-Latarjet patients (4 HA, 6 aTSA, 13 rTSA) with a 2:1 matched control group. Outcomes included range of motion, functional scores (absolute and relative Constant-Murley Score [aCS and rCS], Subjective Shoulder Value), complications, revisions, and radiographic findings. Kaplan-Meier survival analysis evaluated reintervention-free survival. Demographics were not significantly different between the post-Latarjet and matched cohorts. Patients who underwent HA following a Latarjet demonstrated significantly less improvement in flexion (Δ -10° vs. 50°), abduction (Δ 5° vs. 70°), and external rotation (Δ -15° vs. 30°) compared to their matched controls (all P < .05). Moreover, the improvement in aCS was significantly lower in the post-Latarjet HA group (13.5 vs. 36 points; P = .042). In the rTSA subgroup, flexion improvement was also significantly reduced in post-Latarjet patients compared to the matched cohort (Δ -10° vs. 37.5°; P = .018). Other functional outcomes (aCS, rCS, Subjective Shoulder Value) were comparable across groups. Complication rates were 75% (HA), 33.3% (aTSA), and 15.4% (rTSA) in the post-Latarjet group, compared to 25% (HA), 33.3% (aTSA), and 11.5% (rTSA) in the matched cohorts. Reintervention-free survival at 60 months was lowest for HA (25%), intermediate for aTSA (66.7%), and highest for rTSA (84.6%), with rTSA showing significantly better survival than HA (P = .009). While clinical outcomes were largely comparable between post-Latarjet patients and matched cohorts, rTSA may offer the most reliable results with lower complication and revision rates than aTSA and HA. It appears to be the preferred option in this complex setting, although post-Latarjet patients showed reduced range of motion.