To Total Shoulder Arthroplasty Research Articles

The 100 Most Impactful Articles on Total Shoulder Arthroplasty: An Altmetric Analysis.

To use the top 100 articles pertaining to total shoulder arthroplasty (TSA) to understand the impact that social media platforms have on the dissemination of shoulder research while highlighting bibliometric factors associated with Altmetric Attention Score (AAS) to offer insight into the impact that social media platforms have on the dissemination, attention, and citation of shoulder research publications. In June 2023, the Altmetric database was searched using the following PubMed MeSH terms: "total shoulder arthroplasty" or "TSA." Articles with the highest AAS were screened to exclude other topics unrelated to TSA. The top 100 articles that met inclusion criteria were used in the final analysis. Bibliometric factors pertaining to each study were collected for further analysis of article characteristics in accordance with prior studies. The Altmetric Database query yielded 1,283 studies. After applying our inclusion criteria, the top 118 articles with the highest AAS were identified. The mean AAS was 29.14 ± 42.35, with a range of 13 to 402. The included articles represented 27 journals, with 70 articles attributed to 2 journals: Journal of Shoulder and Elbow Surgery (JSES; 43%) and the Journal of Bone and Joint Surgery (JBJS; 16%). There was a significant increase in AAS for the presence of a conflict of interest (p = 0.042) and open access status (p < 0.01), but no association between the score and citation rate (p > 0.05). Top articles on TSA, as defined by high AAS, mostly comprise original clinical research performed in the United States or Europe. The presence of a conflict of interest and open access status is associated with an increase in AAS, but there was no association between AAS score and citation rate.

A History of Shoulder Instability is More Common in Young Patients Undergoing Total Shoulder Arthroplasty.

Previous studies have shown an association between shoulder instability and the development of glenohumeral arthritis leading to total shoulder arthroplasty (TSA). The primary goal of this study was to evaluate if a history of shoulder instability was more common in patients under 50 years old undergoing TSA. The secondary objective was to determine if a history of prior surgical stabilization is more common in patients under 50 years old undergoing TSA. Using the military health system data repository (MDR) and the Military Analysis and Reporting Tool (M2), we identified 489 patients undergoing primary TSA from October 1, 2013, to May 1, 2020, within the Military Health System (MHS). Patients under 50 years old were matched 1:2 with patients 50 years and older based on sex, race, and military status, with the final study population comprising 240 patients who underwent primary TSA during the study period. Electronic medical records were examined, and factors showing univariate association p < 0.2 were included in a binary logistic regression analysis to determine associations between demographic/clinical factors and TSA prior to 50 years old. The groups differed significantly in shoulder arthritis subtype, with the older group having significantly more primary osteoarthritis (78% vs. 51%, p<0.001). The younger group had significantly more patients with a history of shoulder instability (48% vs. 12%, p<0.001), prior ipsilateral shoulder surgery of any type (74% vs. 34%, p<0.001), and prior ipsilateral shoulder stabilization surgery (31% vs. 5%, p<0.001). In the resultant logistic regression model, a history of shoulder instability (OR 5.0, p < .001) and a history of any prior ipsilateral shoulder surgery (OR 3.5, p<.001) were associated with TSA prior to the age of 50 years old. Shoulder instability is a risk factor for TSA before 50 years old. It is unclear how surgical stabilization influences the development of secondary glenohumeral arthritis in shoulder instability. Patients should be counseled that recurrent instability could lead to earlier TSA, regardless of whether surgical stabilization is performed.

Pyrocarbon humeral heads for hemishoulder arthroplasty grant satisfactory clinical scores with minimal glenoid erosion at 5-9 years of follow-up

Hemi-shoulder arthroplasty (HSA) is a more conservative alternative to total shoulder arthroplasty (TSA) for young and active patients with minimal glenoid erosion or deformity. Pyrocarbon humeral heads were introduced as an alternative to metallic humeral heads which were associated with glenoid erosion in 28%-43%. The purpose of this study was to evaluate the progression of glenoid erosion and clinical scores of HSA using pyrocarbon humeral heads from short- (2-4 years) to mid-term (5-9 years). We retrieved records of 45 consecutive patients that underwent HSA with pyrocarbon humeral heads from 2013 to 2015. Patients were evaluated radiographically and clinically at a 'first' follow-up (2-4 years) and a 'second' follow-up (5-9 years). Preoperative glenoid morphology was assessed using computed tomography (CT) scans and glenoid erosion was assessed using plain radiographs according to Sperling et al 27. The Constant score (CS), American Shoulder and Elbow Surgeons (ASES) and Subjective Shoulder Value (SSV) score were assessed by an independent observer. From the initial cohort of 45 patients, 2 underwent revision surgery (4.4%) due to persistent pain (without signs of rotator cuff pathology or glenoid erosion), and 6 were lost to follow-up (13%), leaving 37 for outcome assessment (82%). At first follow-up of 2.2 ± 0.4 years all clinical scores improved substantially (CS from 29.3±13.5 to 76.7±14.4, ASES from 23.7±15.6 to 87.0±16.0, and SSV from 25.3±12.2 to 84.1±15.2) and at second follow-up of 6.2 ± 1.2 years good clinical scores were maintained (CS from 76.7±14.4 to 80.8±16.0, ASES from 87.0±16.0 to 92.3±15.0, and SSV from 84.1±15.2 to 82.8±18.3). At second follow-up, glenoid erosion was moderate in 9 (24%) and severe in 3 (8.1%). When comparing to immediate postoperative radiographs, 10 shoulders exhibited progression of glenoid erosion by 1 grade (n=9) or 2 grades (n=1). Pyrocarbon humeral heads for HSA grant satisfactory clinical scores with minimal glenoid erosion.

Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections.

The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections. We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P&lt;0.05. The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00-1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05-2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80-0.95; P=0.003). There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.

YouTube is a poor-quality source for patient information on the rehabilitation following total shoulder arthroplasty

BackgroundDespite the ubiquity of health information on YouTube, the quality of the information as it pertains to total shoulder arthroplasty (TSA) rehabilitation is unknown. The purpose of this study is to investigate the quality of information available on YouTube as it pertains to rehabilitation following TSA, including anatomic and reverse TSA. MethodsUtilizing predefined search terms, 480 videos regarding rehabilitation following TSA were screened for study inclusion. A total of 143 videos were included in the final analysis. Of these, 99 (69.2%) videos were on rehabilitation of anatomical TSA and 44 (30.8%) videos reported on rehabilitation after reverse TSA. Each video was reviewed using 3 scoring systems: (1) Journal of the American Medical Association (JAMA) benchmark criteria, (2) Global Quality Score (GQS), and (3) DISCERN instrument. ResultsYouTube videos regarding TSA are of suboptimal educational quality with a mean JAMA score of 2.5 ± 0.7, mean GQS of 2.7 ± 0.9, and mean DISCERN score of 33.2 ± 5.5 overall. Upon evaluation of video metrics based on classification it was found that educational nonphysician videos had significantly more likes than all other categories (P = .01). Educational physician videos were found to be significantly longer than all other categories (educational physician: 10.0 ± 14.8 minutes, educational nonphysician: 6.2 ± 3.2 minutes, personal testimony: 3.5 ± 2.6 minutes, commercial: 5.8 ± 5.4 minutes; P < .01) and had significantly higher JAMA (P < .01), GQS (P < .01), and DISCERN (P < .01). ConclusionYouTube videos are a poor source of educational information for patients regarding TSA rehabilitation. Educational videos prepared by nonphysicians accrued more likes than other video categories. Although educational videos by physicians provided statistically higher quality educational content as noted by JAMA, GQS, and DISCREN scores, the average scores across all author categories were classified as low (JAMA), moderate to poor (GQS), or poor (DISCERN) quality educational content. Additionally, our findings suggest that physician educational videos that are shorter in duration are more likely to be well received and watched to completion by viewers compared to longer videos. Patients should be provided trusted resources to learn more about TSAs.

Humeral Head Morphology Influences Outcomes of Arthroscopic Interposition Glenoid Patch Allograft for Glenohumeral Arthritis

PurposeTo determine short- to midterm patient-reported outcomes of arthroscopic soft-tissue interposition arthroplasty using acellular dermal allograft with a minimum follow-up of 1 year and to assess outcomes in patients with and without flattening of the humeral head.MethodsPatients with a diagnosis of primary glenohumeral arthritis who underwent arthroscopic soft-tissue interposition arthroplasty with an acellular dermal allograft from July 2010 to November 2019 were retrospectively enrolled. Inclusion criteria were a primary diagnosis of glenohumeral arthritis and Outerbridge 4 full-thickness cartilage loss of ≥50% of the glenoid articular surface. Patients underwent arthroscopic debridement, microfracture, and biological arthroscopic soft-tissue interposition arthroplasty with an acellular dermal matrix. Postoperative outcomes included American Shoulder and Elbow Surgeon (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Penn Shoulder Score (PSS), numeric rating scale (NRS) pain score, analgesic use, and conversion to total shoulder arthroplasty (TSA). Results were stratified according to humeral head morphology on preoperative radiographs.ResultsA total of 25 patients were included, with a mean age of 56.0 years (range 19.2 to 74.8) and a mean follow-up of 3.36 years (range 1.03 to 8.98). The mean postoperative ASES score was 64.1 (range 11.7 to 100.0), SANE score was 62% (range 5% to 100%), and PSS was 61.2 (range 10.6 to 97.9). Additionally, 56% of patients rated their shoulder function as improved or much improved, and 36% of patients converted to TSA at a mean of 2.35 years. Patients with and without humeral flattening had similar postoperative ASES scores (P = .44), SANE scores (P = .90), PSS (P = .73), and conversions to TSA (P = .83). Patients with humeral flattening were more likely to have shoulder pain at night (83.3% versus 28.6%, P = .02).ConclusionArthroscopic soft-tissue interposition arthroplasty with an acellular dermal allograft resulted in satisfactory short- to mid-term postoperative outcomes for younger patients with glenohumeral arthritis but demonstrated a TSA conversion rate of 36%. Patients with humeral head flattening also had satisfactory shoulder function but were more likely to experience shoulder pain at night.Level of EvidenceLevel IV, therapeutic case series

Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Minimum 10-Year Follow-up

Objectives:Glenohumeral osteoarthritis (GHOA) remains a common cause of shoulder pain, loss of shoulder range of motion, and upper extremity dysfunction. Few long-term outcome studies exist evaluating glenohumeral osteoarthritis (GHOA) treatment with arthroscopic management.The purpose of this study was to determine outcomes, risk factors for failure, and survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of GHOA at minimum 10-year follow-up. It was hypothesized that while some patients would progress to total shoulder arthroplasty (TSA), the majority of patients would demonstrate sustained improvement in patient-reported outcomes and satisfaction without conversion to TSA at long term follow-up.Methods:The CAM procedure was performed on a consecutive series of patients with advanced GHOA who opted for joint preservation surgery that otherwise met criteria for total shoulder arthroplasty (TSA). At minimum 10-year follow-up, pre- and post-operative outcome measures collected included the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Short Form–12 (SF-12) Physical Component Summary (PCS), visual analog scale for pain, and satisfaction scores. Kaplan-Meier survivorship analysis was performed with failure defined as progression to arthroplasty.Results:Thirty-eight CAM procedures were performed with 10-year minimum follow-up (range, 10-14 years) with a mean age of 53 years (range, 27-68) at time of surgery. Kaplan Meier survivorship curve showing 75.3% CAM survivorship (Comprehensive Arthroscopic Management) for glenohumeral arthritis at 5 years and 63.2% at 10 years in Figure 1. Those who progressed to arthroplasty did so at a mean of 4.7 years (range, 0.8-9.6 years). For those who did not undergo arthroplasty, ASES scores significantly improved post-operatively at both 5 and 10 years (63.3-89.6, p<0.001; 63.3-80.6, p=.007) (Table 1). CAM failure was associated with severe pre-operative humeral head incongruity in 93.8% of failures compared to 50.0.% of patients who did not go onto arthroplasty (p= 0.008). Median satisfaction was 7.5 out of 10.Conclusions:Significant improvement in patient reported outcomes were sustained at minimum 10-year follow-up in young patients with GHOA who underwent a CAM procedure. Survivorship rate at minimum 10-year follow-up was 63.2%. Humeral head flattening and severe joint incongruity were risk factors for CAM failure. The CAM procedure is an effective joint preserving treatment for GHOA in appropriately selected patients with sustained positive outcomes at 10 years.

Rotational range of motion of elliptical and spherical heads in shoulder arthroplasty: a dynamic biomechanical evaluation

IntroductionElliptical shape humeral head prostheses have been proposed to reflect a more anatomic shoulder replacement. Its effect on the rotational range of motion (ROM) compared to a standard spherical head is still not understood. The purpose was to investigate if there would be a difference in rotational ROM when comparing elliptical and spherical prosthetic heads in a dynamic shoulder model. The authors hypothesized that the use of elliptical heads would result in significantly more rotational ROM compared to the spherical head design.Materials and methodsSix fresh-frozen, cadaveric shoulders were evaluated using a dynamic shoulder model. After being tested in the native condition, each specimen underwent 6 conditions in the hemiarthroplasty state: (1) matched-fit spherical head, (2) oversized spherical head, (3) undersized spherical head, (4) matched-fit elliptical head, (5) oversized elliptical head, and (6) undersized elliptical head. Following conversion to total shoulder arthroplasty (TSA), the 6 prior conditions were rerun. Each condition was tested at 0°, 30° and 60° of glenohumeral abduction. Rotational ROM was quantified using 3-dimensional tracking, while dynamically applying alternating forces for internal and external rotation via the rotator cuff tendons.ResultsElliptical and spherical prosthetic heads showed no significant difference in the degree of the total, internal, and external rotational ROM for both the hemiarthroplasty and TSA state. Conversion from hemiarthroplasty to TSA resulted in less degree of total rotational ROM for both head designs in all abduction positions, without reaching statistical significance. There was a significant decrease in total, internal, and external rotational ROM for both elliptical and spherical heads in every replacement condition, when comparing 0° to 30° and 60° of abduction (P < 0.05, respectively).ConclusionIn a dynamic shoulder model, elliptical and spherical prosthetic head designs showed no significant difference in the degree of the total, internal, and external rotational ROM in both the hemiarthroplasty and TSA state.Level of evidenceControlled laboratory study

Surgeon and Patient Upper Extremity Dominance Does Not Influence Clinical Outcomes After Total Shoulder Arthroplasty.

Background:Surgeon- and patient-specific characteristics as they pertain to total shoulder arthroplasty (TSA) are limited in the literature. The influence of surgeon upper extremity dominance in TSA and whether outcomes vary among patients undergoing right or left TSA with respect to surgeon handedness have yet to be investigated.Purpose:To determine whether surgeon or patient upper extremity dominance has an effect on clinical outcomes after primary TSA at short-term follow-up.Study Design:Case series; Level of evidence, 4.Methods:A retrospective chart review was performed on prospectively collected data from an institutional shoulder registry. Patients who underwent primary TSA for glenohumeral osteoarthritis from June 2008 to August 2012 were included in the study. Preoperative and postoperative American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), and visual analog scale (VAS) pain scores were evaluated. To determine the clinical relevance of ASES scores, the minimal clinically important difference (MCID), the substantial clinical benefit (SCB), and the patient acceptable symptom state (PASS) were used. Active forward elevation, abduction, and external rotation were recorded for each patient. Glenoid version was also evaluated preoperatively on standard radiographs.Results:Included in this study were 40 patients (n = 44 shoulders; mean age, 69.0 ± 7.3 years) with a mean follow-up of 36.5 ± 16.2 months. Final active range of motion between patients who underwent dominant versus nondominant and left versus right TSA by a right-handed surgeon was not significantly different. Clinical outcomes including the ASES, SST, and VAS pain scores were compared, and no statistical significance was identified between groups. With regard to the ASES score, 89% of patients achieved the MCID, 64% achieved the SCB, and 60% reached or exceeded the PASS. No significant difference in preoperative glenoid version between groups could be found.Conclusion:With the numbers available, neither patient nor surgeon upper extremity dominance had a significant influence on clinical outcomes after primary TSA at short-term follow-up.Clinical Relevance:The influence of surgeon and patient upper extremity dominance on TSA outcomes is an important consideration, given the preferential use of the dominant extremity exhibited by most patients during activities of daily living. To this, operating on a right shoulder might be technically more demanding for a right-handed surgeon and vice versa, as it is considered in other subspecialties.

Bariatric Surgery Following Total Shoulder Arthroplasty Increases the Risk for Mechanical Complications Including Instability and Prosthetic Loosening.

While extensive literature has been published on the risks and benefits of bariatric surgery (BS) prior to and following lower-extremity arthroplasty, no similar investigations have been performed on the impact of BS prior to total shoulder arthroplasty (TSA). The objective of the present study was to compare the incidence of mechanical complications in morbidly obese patients who undergo TSA: those who undergo BS following TSA compared with those who do not undergo BS, and those who undergo BS after TSA compared with those who undergo BS prior to TSA. A Medicare database was queried for morbidly obese patients who underwent BS either before or after TSA, as well as those who underwent TSA but no BS. Of 12,277 morbidly obese patients who underwent TSA between 2005 and 2014, 304 underwent BS (165 of them prior to TSA and 139 following TSA) and 11,923 did not undergo BS. Rates of mechanical complications were then compared between groups using a logistic regression analysis. Patients who underwent BS after TSA had significantly higher rates of mechanical complications (12.9%) compared to controls (8.8%) or patients who underwent prior BS (7.9%). Patients who underwent BS after TSA had higher rates of both instability (7.9%) and loosening (8.6%) than did controls (5.1 and 4.9%, respectively) or patients who underwent BS before TSA (4.8 and 4.2%, respectively). BS following TSA is associated with increased rates of mechanical complications, including instability and loosening, compared to BS prior to TSA. These findings suggest that it may be prudent to consider performing BS prior to TSA in morbidly obese patients, rather than waiting until after TSA is performed.

Three dimensional scapular prints for evaluating glenoid morphology: An exploratory study

BackgroundComputerised Tomography (CT) scans are conventionally employed to assess the glenoid morphology prior to total shoulder arthroplasty (TSA). This study explores the role of three-dimensional (3D) models for assessing glenoid morphology. MethodsCT scans of 32 patients scheduled for TSA were reconstructed to scapular models using customised software and a desktop 3D printer. The size and aspect ratios were maintained. Glenoid version, glenoid maximum height and width, and the maximum acromion antero-posterior (AP) length were compared between the models and CT scans. ResultsThe models were an accurate qualitative reflection of scapular anatomy. The average retroversion in 3D models was 8.19°±30.8° compared to 10.26°±42.5° in scan images. The mean difference was 2.07°±24.6° (p=0.408). However, the mean absolute error was 5.02°±12.3°. The mean difference of the glenoid maximum width and the acromion maximum AP length was 0.22±3.33mm (p=0.862) and 0.32±14.12mm (p=0.213) respectively. However, the mean difference was significant for the glenoid maximum height measuring 3.67±12.04mm with p=0.004. The correlation between the examiners was high for all parameters, with intraclass correlation ranging between 0.94 and 0.99. Conclusion3D printing technology promises to be a useful tool for preoperative planning with accurate reproduction of transverse plane anatomy. 3D prints represent superior definition of reconstructed anatomical measures such as glenoid height as compared to conventional CT Scans.

Distribution of High-Volume Shoulder Arthroplasty Surgeons in the United States: Data from the 2014 Medicare Provider Utilization and Payment Data Release.

Access to total shoulder arthroplasty (TSA) may become a concern in the United States because of an aging and active population resulting in increased demand. As high-volume TSA surgeons have demonstrated superior outcomes, access to these surgeons is a matter of patient and public health policy interest. The release of the 2012 Medicare Provider Utilization and Payment Data Public Use File (MPUPD-PUF) in 2014 provided volume and reimbursement data for procedures performed by individual physicians participating in Medicare. This study analyzed surgeon prevalence, surgeon distribution, and factors associated with higher or lower surgeon prevalence in metropolitan areas. The MPUPD-PUF was reviewed for the 2012 calendar year, and data were extracted for all physicians who performed a minimum of 11 TSA procedures for Medicare beneficiaries. Physicians in each major metropolitan area (population of >1 million) were grouped together. Average reimbursement, number of high-volume TSA surgeons, and number of total procedures were calculated per major metropolitan area. The presence of an American Shoulder and Elbow Surgeons (ASES) fellowship program and mean geographic reimbursement were analyzed for association with the number of high-volume TSA surgeons. The MPUPD-PUF included 774 surgeons across the United States who performed an annual minimum of 11 TSA procedures covered by Medicare, with a combined total of 19,505 TSA procedures. Of these surgeons, 45% practiced within major metropolitan areas with a population of >1 million. Surgeons who had completed an ASES fellowship had a higher volume of procedural claims (median, 26; range, 11 to 120) compared with other surgeons (median, 17; range, 11 to 163; p < 0.001). The distribution among major metropolitan areas was highly unequal, and more surgeons were present in cities with an ASES fellowship program. Access to high-volume shoulder arthroplasty surgeons by the Medicare population is lacking in multiple major metropolitan areas in the United States because of the uneven distribution of these surgeons. The method of analysis in this study allows for opportunities to target training programs as well as placement of physicians to ensure access to high-volume shoulder arthroplasty surgeons.

Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis

Background: There are little data on midterm outcomes after the arthroscopic management of glenohumeral osteoarthritis (GHOA) in young active patients. Purpose: To report outcomes and survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of GHOA at a minimum of 5 years postoperatively. Study Design: Case series; Level of evidence, 4. Methods: The CAM procedure was performed on a consecutive series of 46 patients (49 shoulders) with advanced GHOA who met criteria for shoulder arthroplasty but instead opted for a joint-preserving, arthroscopic surgical option. The procedure included glenohumeral chondroplasty, capsular release, synovectomy, humeral osteoplasty, axillary nerve neurolysis, subacromial decompression, loose body removal, microfracture, and biceps tenodesis. Outcome measures included the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Short Form–12 (SF-12) Physical Component Summary (PCS), visual analog scale for pain, and satisfaction scores. Kaplan-Meier survivorship analysis was performed with failure defined as progression to total shoulder arthroplasty (TSA). Results: Forty-six consecutive patients (49 shoulders) who underwent a CAM procedure at a minimum of 5 years from surgery were included. Two patients were excluded for refusing to participate before study initiation. The mean age at surgery was 52 years (range, 27-68 years) in 15 women and 29 men. All patients were recreational athletes with 7 former collegiate or professional athletes. Twelve shoulders (26%) progressed to TSA at a mean of 2.6 years (range, 0.5-8.2 years). For survivorship analysis, the status of the shoulder (preservation of the native joint or progression to TSA) at a minimum of 5 years was known for 45 of 47 (96%) shoulders. Survivorship was 95.6% at 1 year, 86.7% at 3 years, and 76.9% at 5 years. For surviving shoulders, minimum 5-year subjective outcome data were available for 28 of 32 (87.5%) shoulders at a mean of 5.7 years (range, 5-8 years). The mean (±SD) ASES score was 84.5 ± 17, the mean SANE score was 82 ± 18, the mean QuickDASH score was 15 ± 13, the mean SF-12 PCS score was 51.0 ± 9.1, and median patient satisfaction was 9 of a possible 10 points. Conclusion: This study demonstrates significant improvements in midterm clinical outcomes and high patient satisfaction after the arthroscopic CAM procedure for GHOA, with a 76.9% survivorship rate at a minimum of 5 years postoperatively. For patients looking for an alternative to TSA, the CAM procedure can provide reasonable outcomes and should be considered an effective procedure in appropriately selected, young active patients. Further studies are warranted to evaluate long-term outcomes and durability after this procedure.

Hemiarthroplasty versus Total Shoulder Arthroplasty For Shoulder Osteoarthritis

Objectives:Return to activity is a commonly used indication for shoulder hemiarthroplasty (HA) in comparison to total shoulder arthroplasty (TSA). Despite clinical studies demonstrating better functional outcomes after TSA, the literature has failed to show a difference in return to sport. The purpose of this study was to compare rates of return to sports in a matched cohort of TSA and HA patients with a preoperative diagnosis of glenohumeral osteoarthritis (OA).Methods:A prospectively collected registry was queried retrospectively for consecutive patients who underwent HA. Inclusion criteria were preoperative diagnosis of OA and > 2 years of follow up. After inclusion criteria, all HA were statistically matched to a TSA patient by preoperative diagnosis, age (+/- 5 yrs), sex, and follow up period (+/- 6 months). At final follow up both cohorts completed a questionnaire regarding physical fitness and sporting activities.Results:40 HA and 40 TSA were available at final follow up. Average age at surgery was 65.7 years for HA and 66.2 year for TSA (p=0.06). Average follow up was 62.0 months for HA and 61.1 months for TSA (p=0.52). Average ASES scores improved for HA from 36.3 to 70.2 (p<0.001) and for TSA they improved from 34.0 to 78.5 (p<0.001). Final ASES scores were not significantly different between groups (p=0.21). Average VAS scores improved for HA from 6.3 to 2.2 (p<0.001), while TSA improved from 6.1 to 0.6 (p<0.001). HA patients had significantly worse final VAS scores compared to the TSA group (p=0.002). 70% (28) of HA patients compared to 15% (6) of TSA patients complained of postoperative problems with their shoulder (p<0.001). Significantly more TSA were satisfied with their surgery (p=0.01). 65.5% (19/29) of HA patients returned to at least one sport postoperatively compared to 97.3% (36/37) of TSA patients (p<0.001). Average timing for return to full sports was 5.5±4.2 months for HA and 5.4±3.1 months for TSA (p=0.92). Significantly more TSA patients returned to higher upper extremity use sports (p=0.01).Conclusion:In patients with OA, rate of return to sports was significantly better after TSA compared to HA. HA patients had significantly more pain, worse surgical satisfaction and decreased ability to return to high upper extremity use sports. For OA patients wishing to return to sporting activities, these result help manage expectations.

Impact of Race and Gender on Utilization Rate of Total Shoulder Arthroplasty.

Marked underutilization rates of total joint arthroplasty in minorities compared with nonminorities exist, with a paucity of literature surrounding inequities related to total shoulder arthroplasty (TSA). Using the Statewide Planning and Research Cooperative System database, patients who underwent elective TSA in New York State (NYS) were identified and characterized by age, race, gender, medical comorbidities, and payor status. Patients were stratified into 4 separate 5-year periods from 1990 to 2009. Comorbidity severity was defined using the Elixhauser criteria. A total of 10,538 elective TSAs were identified, with half of the procedures occurring in the most recent time quartile. Whites accounted for 70% of the procedures, whereas blacks accounted for 5%. During the 20-year period, the age-adjusted incidence of TSA in white men and women increased by 417% and 421%, respectively, whereas the incidence for black men and women increased by 378% and 329%, respectively. Black men had the lowest utilization rate among all subgroups, and overall disparity between races continued to widen over time. Blacks had significantly more comorbid conditions (P<.001) than whites when undergoing TSA. Blacks were more likely to have Medicaid insurance and less participation in Medicare (P<.001). Racial and gender disparities clearly exist in TSA utilization rates in NYS and may be worsening. Although reasons for these disparities are likely multifactorial, a deeper understanding of the factors involved in patient selection and access to care is necessary to appropriately address these disparities and effect change at a system-wide patient and provider level. [Orthopedics. 2016; 39(3):e538-e544.].

Glenoid Component Failure After Total Shoulder Arthroplasty With Migration of the Component Into Posterior Subcutaneous Tissue: A Case Report

Glenoid component loosening is the most frequently cited complication related to total shoulder arthroplasty (TSA). The mechanism behind glenoid loosening remains an area of active investigation. Distant migration of the implant following loosening has not been described. Both glenoid implant removal and revision have demonstrated successful results following symptomatic loosening. This report presents the case of a 61-year-old female who experienced a complete glenoid component dissociation following TSA with migration of the implant into the subcutaneous tissue of the posterior shoulder. The patient underwent implant removal without glenoid revision and has experienced an excellent outcome at midterm follow-up. Although glenoid component loosening remains the most common complication associated with TSA, this particular scenario and the subsequent management have not been previously reported.

Revision total shoulder arthroplasty for painful glenoid arthrosis after humeral head replacement: the nontraumatic shoulder

Patients treated with humeral head replacement (HHR) may require revision to total shoulder arthroplasty (TSA) due to glenoid arthrosis. This study characterizes the outcomes of revision TSA in patients who initially underwent HHR for nontraumatic glenohumeral arthritis. From 1982 to 2005, 68 shoulders underwent revision TSA for glenoid arthrosis. The initial HHR was performed for non-fracture-related arthritis. Revisions were grouped according to complexity for analysis. Stem revision and soft tissue reconstruction were assessed in relation to outcome. Pain scores decreased from 4.4 to 2.8, abduction increased from 85° to 116°, external rotation increased from 36° to 48°, and internal rotation remained unchanged. Survivorship free of repeat revision was 95.6%, 84.1%, and 72.9% at 1, 5, and 10 years. The Neer rating yielded 20 excellent, 10 satisfactory, and 38 unsatisfactory outcomes. No differences in motion, survivorship, or the Neer rating occurred between groups by procedure complexity. There was, however, less reduction in pain for the group requiring a humeral stem revision. Of the 9 shoulders with postoperative instability, 7 had compromised soft tissues preoperatively. Revision TSA after HHR results in decreased pain and increased motion. Result ratings, however, are quite variable and, in many cases, unsatisfactory. Stratification of the procedures according to complexity does not demonstrate differences in motion, satisfaction, or survivorship. Stem revision, however, results in reduced pain score improvement. Coexisting instability associated with subscapularis and anterior shoulder capsule damage may not be correctable using an unconstrained shoulder arthroplasty.

Total shoulder arthroplasty for the treatment of failed hemiarthroplasty in patients with fracture of the proximal humerus

Little information is available for the outcomes of conversion to total shoulder arthroplasty (TSA) of failed hemiarthroplasty (HA) implanted for fractures or fracture-dislocations of the proximal humerus. We evaluated the clinical and radiographic results in 16 patients who underwent conversion of HA to TSA due to pain and shoulder disfunction. Patients were a mean age of 63 years at revision, which was occurred a mean of 3.3 years after the HA. The main prerequisites for conversion were forward flexion to at least 60°, no massive cuff tear, or severe resorption or nonunion of the tuberosities. In all cases, a modular prosthesis was used in the HA, uncemented in 14 and cemented in 2. The latest follow-up was a mean of 4.6 years after revision. The mean Constant score was 50.6 (range, 33-69), with an average increase of 11.9 points compared with the preoperative score (P = .001). In 75% of patients, the mean score was 54.6 (average increase, 15.1 points). The lowest scores occurred in patients with a cemented prosthesis that needed to be removed, and in 1 patient who had loosening of the implanted glenoid that was revised. Conversion of HA to TSA can improve the preoperative condition in most patients aged in their 50s or 60s in the absence of rotator cuff deficiency and severe bone loss of the proximal humerus.

Outcomes of Shoulder Arthroplasty After Failure of Biological Resurfacing of the Glenohumeral Joint (SS-24B)

Introduction This study reports the outcomes of patients undergoing total shoulder arthroplasty following failed management of degenerative joint disease with biological resurfacing of the glenoid. The purpose of this study is to report the results of patients who underwent biological resurfacing and were later converted to total shoulder arthroplasty (TSA). Methods Seven patients (mean age 37.4 ± 10.3 years) treated with biologic resurfacing of the glenoid using lateral meniscal allograft (5 patients) or human acellular dermal tissue matrix (2 patients) failed the procedure and were converted to TSA after an average of 2.0 ± 1.4 years. All patients were available for follow up at an average of 3.3 ± 1.8 years. Results Only limited improvement was observed post-conversion. Forward flexion and external rotation improved from 103.3° ± 34.4° and 28.3° ± 12.9° to 109.4° ± 52.9° and 41.0° ± 14.8°, respectively. The mean ASES, SST, and VAS scores for this group were 29.5 ± 12.1, 1.0 ± 1.4, and 6.25 ± 1.7 preoperatively and 38.3 ± 18.6, 3.7 ± 3.5, and 5.3 ± 1.9 postoperatively, respectively. The threshold of failure was set at an ASES score of Conclusion Biological interposition arthroplasty is designed to postpone the need for prosthetic glenoid components and thus delay the risks associated with polyethylene glenoid implants such as component wear, fragmentation, and glenoid loosening or disassociation. The poor clinical outcomes seen in patients who are converted to a TSA after failure of biological resurfacing suggests that TSA may be the preferred primary procedure in young patients with severe glenohumeral arthritis.

Results of revision from hemiarthroplasty to total shoulder arthroplasty utilizing modular component systems

Hemiarthroplasty continues to be a common surgical treatment for glenohumeral arthritis. Unfortunately, some patients will develop painful glenoid arthrosis necessitating revision to total shoulder arthroplasty. Previously reported results of revision have demonstrated variability in results and difficulty. The purpose of this study was to determine the difficulty and results of revision from hemiarthroplasty to total shoulder arthroplasty utilizing modular component systems. Between 1995 and 2007, the authors identified 15 patients who underwent revision from hemiarthroplasty (HA) to total shoulder arthroplasty (TSA). Patients were assessed with the use of a UCLA score and a visual analogue scale at the time of the latest follow-up (mean, 40 months; range, 24-70 months). Radiographs were assessed for the presence of glenoid loosening, subluxation, and shift in component position. Revision HA to TSA was significantly associated with pain relief (P < .01) as well as improvement in forward elevation from a mean of 91° to 141°. According to the UCLA scoring, the result was excellent in 9 shoulders, good in 5, and fair in 1. No instances of humeral or glenoid loosening were identified at the most recent examination. Only 2 stem revisions were necessary in this series of modular shoulder arthroplasties. The data from this study suggest that revision of painful HA for glenoid arthrosis to TSA is a reliable procedure with good improvements in pain, range of motion, and function. With modular components, the complexity of the procedure is minimized. Poor results and the need for stem revision are infrequent occurrences.