Impact of enhanced recovery after surgery protocols on patient-reported outcomes and satisfaction following shoulder arthroplasty: a systematic review.

A systematic review of surgical treatment of reverse shoulder arthroplasty associated acromial and scapular spine stress fractures.

Reverse total shoulder arthroplasty (rTSA), once reserved for elderly low-demand patients, is increasingly used in younger adults despite concerns regarding complication rates and longevity. This systematic review and meta-analysis evaluate contemporary evidence on primary rTSA in patients aged ≤65 years. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, PubMed, Scopus, and CENTRAL databases were searched to October 2025. Studies reporting outcomes of primary rTSA in patients ≤65 years with ≥2 years of follow-up were included. Data on indications, functional outcomes, range of motion (ROM), patient-reported outcome measures (PROMs), complications, revisions, and implant survival were recorded and synthesized. Subgroup analyses based on patients' age and comparisons with older rTSA cohorts were also performed. Thirteen studies met our inclusion criteria. Cuff tear arthropathy (27.29%), massive cuff tears (23.39%), and glenohumeral osteoarthritis (22.34%) accounted for most indications. rTSA resulted in significant improvements in ROM and all major PROMs. The overall complication rate was 14.23%, and the revision rate was 2.92%, with instability and infection responsible for 64.2% of revisions. Mid- to long-term implant survival exceeded 85%. When compared with older patients, younger adults demonstrated equivalent ROM outcomes. Concerning PROMs younger patients demonstrated inferior American Shoulder and Elbow Surgeons (mean difference [MD] = -6.43, P = .01), visual analog scale (MD = 0.93, P < .01), Constant score (MD = -4.98, P < .01), University of California Los Angeles (MD = -2.07, P < .01), and Shoulder Pain and Disability Index (MD = 13.56, P < .01), whereas Simple Shoulder Test (MD = -0.7, P = .19) did not differ between the 2 groups. Moreover, younger patients presented a higher revision risk (risk ratio [RR] = 2.21, P < .01). Primary rTSA provides substantial and predictable improvements in pain and shoulder function among young adults, with acceptable early- to mid-term durability. Nevertheless, younger age remains associated with higher revision risk and modestly lower subjective outcomes, likely reflecting greater functional demands and post-operative expectations. These findings highlight the importance of nuanced surgical decision-making and patient counseling as rTSA use continues to expand in this demographic.

Biomechanical evaluation of acromion and scapular spine fracture repair techniques systematic review.

What does infection cost? A comparative analysis of shoulder, hip, and knee two-stage revision procedures.

Beyond the "two-midnight rule": social factors drive prolonged stay after outpatient total shoulder arthroplasty.

Bone resorption around cementless short humeral stems is increasingly recognized after shoulder arthroplasty, but quantitative longitudinal data are lacking. We measured bone mineral density (BMD) around the humeral component after anatomical total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (RSA) using dual-energy X-ray absorptiometry (DEXA) and evaluated the time-course changes over two postoperative years. Additionally, we investigated the association between osteoporosis and clinical outcomes. The subjects were patients who underwent aTSA or RSA, and for whom DEXA evaluation was available at three weeks, six months, one year, and two years postoperatively. The area around the humeral component was divided into five zones, and the BMD of each zone was measured. To evaluate clinical outcomes, we investigated their association with osteoporosis and measured the postoperative American Shoulder and Elbow Surgeons (ASES) score using the minimal clinically important difference (MCID) as the reference. Overall, 94 RSAs and 43 aTSAs were observed. In RSA, BMD decreased significantly over time in zones 3 and 5 (both p < 0.05). In aTSA, BMD decreased in zones 2, 3, and 4 from three weeks to six months, with little sustained decrease thereafter. Additionally, in RSA, a decrease in zone 3 BMD was significantly associated with osteoporosis (both p < 0.05). Failure to achieve the MCID for the ASES score was also significantly associated with both zone 3 BMD loss and osteoporosis (both p < 0.05). Time-course changes in BMD around cementless short humeral components differed between aTSA and RSA. In RSA, BMD decreased over time in zones 3 and 5. Zone 3 BMD loss was significantly associated with osteoporosis, and both zone 3 BMD loss and osteoporosis were linked to failure to achieve the MCID for the ASES score. These findings suggest that patients undergoing RSA with osteoporosis may benefit from careful postoperative follow-up, including monitoring of periprosthetic bone loss and optimization of osteoporosis management.

Improving bone mineral density assessment in total shoulder arthroplasty: assessment of phantom-calibrated Hounsfield units in the glenoid and proximal humerus.

This study evaluated the short-term clinical and radiological outcomes of an uncemented isoelastic monoblock glenoid component in stemless anatomic total shoulder arthroplasty (aTSA). We hypothesized that the implant's design and biomechanical properties would offer sufficient fixation and good functional outcomes. In this prospective multicenter study, 75 patients received stemless aTSA for shoulder osteoarthritis using the Affinis Glenoid vitamys implant. We evaluated 64 patients at a mean follow-up of 25.2 ± 2.1 months. The Constant Score, Simple Shoulder Test, active range of motion, and complications were recorded. The radiological evaluation was based on the occurrence of radiolucent lines (RLLs) and periprosthetic bone adaptations using plain radiographs and scored according to Lazarus and Molé. Clinical scores and range of motion outcomes improved significantly after surgery (P < .001). The radiological evaluation revealed minor humeral periprosthetic bone adaptations without clinical consequences. RLLs on the glenoid side were detected in 31.5% of cases; most (62%) of them were < 2 mm. The mean adapted Molé score was 1.08 ± 2.34. Since the majority of observed RLLs were not located around the pegs, 95% of the investigated implants were classified 0 according to Lazarus. Finally, no revision surgery was necessary due to failed fixation or loosening of the glenoid component. Stemless aTSA with the uncemented isoelastic monoblock Affinis Glenoid vitamys yielded good and reliable short-term radiological and clinical results. Studies with a longer follow-up period are necessary to confirm these results.

Total shoulder arthroplasty (TSA) is increasingly used to treat a range of shoulder disorders. Although TSA improves pain and function, its cost-effectiveness remains uncertain. This systematic review evaluated the cost-effectiveness of TSA for glenohumeral arthritis, rotator cuff arthropathy, massive rotator cuff tears and proximal humerus fractures. We systematically searched MEDLINE, Embase, and CINAHL from inception to July 2025 for full economic evaluations comparing TSA with surgical or non-operative alternatives. Eligible studies included primary anatomical total shoulder arthroplasty (ATSA) or reverse total shoulder arthroplasty (RTSA). Studies could be randomised, observational or model-based, and had to provide costs and outcomes to allow determination of an incremental cost-effectiveness ratio or equivalent expression. Study quality was assessed with the Drummond checklist. Given study heterogeneity, results were synthesised narratively. Of 308 potentially eligible studies, 26 were included, comprising 15,163 patients, all of which were conducted in high-income countries. Fifteen studies were modelled, relying on published literature for costs and outcomes. Most studies were rated as fair (58%) or good (38%) quality. In four studies regarding osteoarthritis, ATSA was consistently cost-effective or dominant (more effective and less costly) over hemiarthroplasty. In three studies regarding osteoarthritis with intact rotator cuff, ATSA and RTSA were similarly effective, and costs were similar or less for ATSA, depending on patient age. In four studies regarding proximal humerus fractures, RTSA was cost-effective or dominant over hemiarthroplasty. In three studies regarding massive rotator cuff tears, cuff repair was always substantially less costly and marginally more effective than RTSA. Despite the increasing use of TSA, evidence regarding its cost-effectiveness is limited to a small number of studies from high-income countries. Although TSA might be cost-effective for selected indications, high-quality, randomised, prospective economic evaluations from a diverse range of settings are needed to provide rigorous evidence to guide value-based care in shoulder arthroplasty.

Impact of Severity of Allergy to Beta-lactam Antibiotics on the Perioperative Use of Cephalosporins and Revision Rates following Total Shoulder Arthroplasty.

Is There a Long-Term Benefit to use Patient-Specific Guides for Glenoid Implant Positioning in aTSA? A comparative study at minimum 10 years.

''The Global Glenoid Component Inclination: why scapulothoracic orientation should be considered when defining glenoid component inclination in reverse total shoulder arthroplasty''.

Although os acromiale is often noted on preoperative imaging in patients undergoing reverse total shoulder arthroplasty (rTSA), its clinical significance is ill-defined. The purpose of this study was to compare the clinical outcomes in shoulders with an os acromiale undergoing rTSA with a matched control group. We conducted a retrospective review of a prospectively collected shoulder arthroplasty database for patients who underwent primary rTSA with a minimum 2-year clinical follow-up. Preoperative imaging studies taken within 6 months of surgery were assessed for an os acromiale. Sixty-four shoulders with os acromiale were identified and were matched in a ratio of 1:5 to a control group (n = 320) based on age (within 3 years), sex (exact), preoperative diagnosis, preoperative forward elevation (within 5°) and American Shoulder and Elbow Surgeons score (within five points). Clinical outcome scores, shoulder strength, and active range of motion assessed preoperatively and at latest follow-up as well as the incidence of complications were compared between cohorts. Outcomes of meso- and meta-acromion were grouped and compared with preacromion shoulders. The incidence of os acromiale was 9.7% (64/663) in our institution. Of these, 55% (n = 34) were preacromion, 38% (n = 24) were mesoacromion, and 8% (n = 5) were meta-acromion. No statistically significant differences were found in any outcome score, shoulder strength, or range of motion measures between shoulders with os acromiale and matched controls. Similar proportions of each cohort achieved a clinically significant benefit (minimal clinically important difference/substantial clinical benefit) for the Shoulder Pain and Disability Index, Simple Shoulder Test, American Shoulder and Elbow Surgeons score, constant score, abduction, forward flexion, external rotation, and internal rotation. Shoulders with os acromiale had a similar overall complication rate compared with matched controls (14% vs. 12%; P = 0.658). No statistical difference in outcomes were observed between the pre- and meso-/meta-acromion shoulders. Patients with os acromiale undergoing rTSA have similar postoperative functional outcomes and pain relief compared with matched controls. Ⅲ, Retrospective Matched Cohort Study.

Evaluation of new normal after shoulder arthroplasty: comparison of anatomic vs. reverse total shoulder arthroplasty.

Accurate preoperative assessment of glenoid bone loss is critical in revision shoulder arthroplasty. The aim of this study was to evaluate the reliability of the Blueprint Revision 3D-CT planning software (Stryker, Kalamazoo, MI, USA) by comparing preoperative reconstructions with intraoperative findings. Agreement between preoperative and intraoperative assessments was analyzed for glenoid containment status, comparing 2D-CT and 3D reconstructed images derived from CT imaging (3D-CT) with intraoperative findings. Forty-seven patients undergoing revision of the same stemless anatomic total shoulder arthroplasty with a cemented polyethylene glenoid component were included in this analysis. Glenoid bone defects were classified using the established systems according to Antuña and Williams-Iannotti. Defect containment (contained vs. uncontained) was assessed preoperatively using 3D-CT and 2D-CT imaging and compared with intraoperative findings. Agreement between different imaging methods was evaluated using Cohen's kappa coefficient (κ). The most common indication for revision was glenoid loosening (79%), with a mean time to revision of 7 ± 3 years. Intraoperative evaluation classified 68.1% of glenoid defects as contained, which was correctly depicted in 80.9% of 3D-CT and 65.9% of 2D-CT. Agreement between 3D-CT and intraoperative findings was moderate (κ = 0.58, 80.9%) and outperformed 2D-CT (κ = 0.37, 65.9%). Agreement between 3D-CT and 2D-CT was also moderate (κ = 0.48, 72.3%). 3D-CT-based preoperative planning using Blueprint Revision demonstrates higher agreement with intraoperative findings compared to traditional 2D imaging. These findings support the value of advanced 3D planning tools in evaluating glenoid containment and guiding surgical decision-making in revision shoulder arthroplasty.

Stemless anatomic and reverse shoulder arthroplasty in patients under 55 years of age with primary glenohumeral osteoarthritis: an analysis of the Australian Orthopedic Association National Joint Replacement Registry at 5 years.

Acromial stress fractures and reactions after reverse total shoulder arthroplasty: a case-control study.

B2 and B3 glenoid osteoarthirtis: outcomes of corrective and concentric (C2) reaming of the glenoid combined with pyrocarbon hemiarthroplasty.

Inconsistencies in Terminology Used to Describe Reverse Shoulder Arthroplasty: A Systematic Review.