Use Of Total Shoulder Arthroplasty Research Articles

Judicious use of corticosteroid injections prior to shoulder arthroplasty does not compromise outcomes at a minimum of 2 years following surgery

BackgroundThe use of total shoulder arthroplasty is continuing to rise with its expanding indications. For patients with chronic conditions, such as glenohumeral arthritis and rotator cuff arthropathy, nonoperative treatment is typically done prior to arthroplasty and often includes corticosteroid injections. Recent studies in the shoulder arthroplasty literature as well as applied from the hip and knee literature have focused on the risk of periprosthetic infection. Literature is lacking as to whether the judicious use of corticosteroids in the year prior to arthroplasty influences patient reported outcomes. The purpose of this study was to determine if preoperative corticosteroid injections prior to shoulder arthroplasty affected two-year patient-reported outcomes. MethodsRetrospective review of anatomic and reverse total shoulder arthroplasty patients (n=230) was performed at a single institution including multiple surgeons. Patients were included if they had preoperative and a minimum of 2-year postoperative patient reported outcomes, including: ASES, VAS, SANE, VR12-PCS, and VR12-MCS. Patients were included in the injection group if they had received an injection, either glenohumeral or subacromial, within twelve months prior to arthroplasty (inject=134). Subgroup analysis included anatomic (TSA=92) and reverse total shoulder arthroplasty (RSA=138) as well as those with no injection within 12 months prior to surgery. An ANOVA was used to compare outcomes between patients who received an injection and those who did not prior to TSA and RSA. ResultsThere were 230 patients included with 134 patients in the injection group and 96 in the no injection group. Patients who received an injection in the year prior to arthroplasty displayed a significantly higher ASES [82 (16.23SD) vs. 76 (19.43SD), p < .01] and SANE [70 (24.49SD) vs. 63 (29.22SD), p < .01] scores versus those who had not received injection. There was no difference when comparing preoperative injection versus no injection in patients undergoing TSA. Those patients undergoing RSA displayed significantly higher ASES scores (p<.01). There were no significant differences in VAS, VR12-PCS, and VR12-MCS among any analysis (P>0.05), and the MCID in ASES was not different between groups (p.09). ConclusionCorticosteroid injections within twelve months prior to anatomic and reverse total shoulder arthroplasty do not compromise patient reported outcomes during a minimum of two-year follow-up. Although more complications occurred in the injection group, it did not reach statistical significance and warrants further study in a larger population.

Glenoid bone loss in shoulder arthroplasty: a narrative review.

Crucial to the success of any total or reverse shoulder arthroplasty (RSA) is the stability of the glenoid component fixation. Instability can lead to early implant failure and unsatisfactory results. Patients often present with varying forms of glenoid bone loss (GBL) in both the primary and revision settings, which can be a challenge for the treating surgeon. Severe cases of GBL can increase the risk of potential complications and diminish implant longevity. The use of the reverse total shoulder replacement has been particularly helpful when addressing significant glenoid bony defects. Various approaches have been proposed to deal with GBL, all of which require an individualized assessment of the specifics of the defect in order to provide maximal fixation and thereby optimize the longevity of the shoulder arthroplasty. This article aims to review the recent literature on GBL in shoulder arthroplasty to provide guidance when considering treatment based on the best available evidence. PubMed, MEDLINE, EMBASE, AccessMedicine, ClinicalKey, DynaMed, and Micromedex were queried for publications utilizing the following keywords: "glenoid bone loss" AND "glenoid bone deficiency" AND "shoulder arthroplasty" AND "classification". The search was restricted to research published between 2004 and 2023. There were no restrictions on study type or language. GBL should be critically evaluated prior to undertaking total shoulder arthroplasty (TSA). The treating surgeon should be aware of various methods of addressing bone defects. The use of TSA is increasing to address various shoulder pathologies. Addressing glenoid bone defects is of critical importance to maximize the longevity and outcome of TSA.

Short-Term Outcomes After Total Shoulder Arthroplasty in Octogenarians: A Matched Analysis.

IntroductionStudies have shown that the use of total shoulder arthroplasty is increasing every year in the United Stated at a rate higher than that of total hip or total knee arthroplasty. As the population of the United States continues to age, it is becoming more important for surgeons to understand the true impact of age on outcomes and complications following procedures such a total shoulder arthroplasty. The purpose of this study was to determine if octogenarians have poorer outcomes after total shoulder arthroplasty compared to a younger, matched control group.MethodsData was obtained through the American College of Surgeons National Surgical Quality Improvement Program database (ACS NSQIP). Patients who had undergone total shoulder arthroplasty were identified by Current Procedural Terminology code (23472). Indication for arthroplasty was determined by ICD9/10 code (osteoarthritis, fracture, other). Each octogenarian was matched 1:1 to a non-octogenarian based on sex, BMI, ASA class, medical comorbidities, functional status, and surgical indication for arthroplasty by propensity scoring. A subgroup analysis was performed to compare outcomes between only those patients who underwent TSA for osteoarthritis.Outcomes of interest were assessed between the two groups for statistical significance using a chi-squared test or fisher exact test for expected values of less than 5. Statistical significance was set at p<0.05.ResultsAfter matching, octogenarians were found to be at higher risk of readmission (4.7% vs. 3.3%, p=0.046), non-home discharge (27.1% vs. 9.4%, p<0.001), and overall surgical (4.4% vs. 2.5%, p=0.006) and medical complications (3.7% vs. 2.4%, p=0.039). In the setting of TSA for osteoarthritis only, however, octogenarians were only at higher risk for non-home discharge (22.4% vs. 7.5%, p<0.001).ConclusionsOctogenarians are at higher risk of some complications following total shoulder arthroplasty but fewer than has been previously reported, particularly in the setting of arthroplasty for the treatment of arthritis.

Increased Use of Total Shoulder Arthroplasty and Improved Patient-reported Outcome for Osteoarthritic Patient in Denmark From 2006 to 2015: A Nationwide Cohort Study From the Danish Shoulder Arthroplasty Registry

Increased Use of Total Shoulder Arthroplasty and Improved Patient-reported Outcome for Osteoarthritic Patient in Denmark From 2006 to 2015: A Nationwide Cohort Study From the Danish Shoulder Arthroplasty Registry

Increased use of total shoulder arthroplasty for osteoarthritis and improved patient-reported outcome in Denmark, 2006–2015: a nationwide cohort study from the Danish Shoulder Arthroplasty Registry

Background and purpose — Osteoarthritis has become the most common indication for shoulder arthroplasty in Denmark, and the treatment strategies have changed towards the use of anatomical total shoulder arthroplasty and reverse shoulder arthroplasty. We investigated whether changes in the use of arthroplasty types have changed the overall patient-reported outcome from 2006 to 2015.Patients and methods — We included 2,867 shoulder arthroplasties performed for osteoarthritis between 2006 and 2015 and reported to the Danish Shoulder Arthroplasty Registry. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index at 1 year was used as patient-reported outcome. The raw score was converted to a percentage of a maximum score. General linear models were used to analyze differences in WOOS.Results — The proportion of anatomical total shoulder arthroplasty and reverse shoulder arthroplasty increased from 3% and 7% in 2006 to 53% and 27% in 2015. The mean WOOS score was 70 (SD 26) after resurfacing hemiarthroplasties (n = 1,258), 68 (SD 26) after stemmed hemiarthroplasty (n = 500), 82 (SD 23) after anatomical total shoulder arthroplasties (n = 815), and 74 (SD 23) after reverse shoulder arthroplasties (n = 213). During the study period, the overall WOOS score increased with 18 (95% CI 12–22) in the univariate model and 10 (CI 5–15) in the multivariable model, and the WOOS scores for anatomical total shoulder arthroplasty increased by 14 (CI 5–23).Interpretation — We found an increased WOOS score from 2006 to 2015, which was primarily related to a higher proportion of anatomical total shoulder arthroplasty and reverse shoulder arthroplasty towards the end of the study period, and to improved outcome of anatomical total shoulder arthroplasty.

Trends and Variability in the Use of Total Shoulder Arthroplasty for Medicare Patients.

As policies are implemented to encourage high-quality care, it is important to identify any persistent limitations to the uniform delivery of anatomic and reverse total shoulder arthroplasty (TSA). The study's goal was to assess current TSA use and identify predictors of geographic variability. We used data from 2012 through 2014 that was obtained from public Medicare databases to identify the case volume, locations, and names of surgeons performing >10 TSAs annually. We also recorded regional characteristics of the Medicare population, including demographic characteristics and health factors. From 2012 through 2014, the number of surgeons performing >10 TSAs annually increased from 824 to 1,060-an increase ranging from 0.75 to 0.95 TSAs per 1,000 beneficiaries. In 2012, there were 59 hospital referral regions with no TSAs performed; the number of regions decreased to 35 by 2014 (P = 0.009). The use of TSA varied widely across regions (range, 0.1 to 6.4 per 1,000 beneficiaries). A larger proportion of white patients and a smaller proportion of patients eligible for Medicaid were independent predictors for increased use of TSA. Despite this finding, 74.4% and 96.9% of the US population resided within 50 km and 200 km, respectively, of a surgeon performing at least 20 TSAs in Medicare patients annually. TSA utilization in the Medicare population is increasing across the country. Although notable geographic disparities in the use of TSA persist, increased TSA utilization has provided greater access to surgeons with high-volume TSA caseloads. Substantial geographic variation in TSA use remains, largely due to socioeconomic factors.

Predictors for satisfaction after anatomic total shoulder arthroplasty for idiopathic glenohumeral osteoarthritis.

The use of total shoulder arthroplasty (TSA) to treat primary glenohumeral osteoarthritis (GHOA) is increasing. Factors influencing patient satisfaction after surgery have not been well documented. The aim of this study was to determine demographic, radiologic, and surgical, factors predictive for satisfaction after TSA for GHOA. Between 2005 and 2012, 95 shoulders undergoing TSA for GHOA by a single surgeon were eligible for inclusion in the study. Age, gender, previous surgeries, American Society of Anesthesiologists (ASA) score, and Walch glenoid morphology were analyzed as satisfaction predictors. Patients with Walch glenoid type C were excluded. Data on 80/92(87%) shoulders were available at a mean of 3years (range 2-9). Three complications (3%) and 2 failures (2%) occurred. The outcome scores collected significantly improved from preoperative values (p<0.05). Median patient satisfaction was 10/10. Gender, age, previous surgery, ASA score, and Walch morphology were not associated with patient satisfaction. TSA provided excellent results for patients with idiopathic GHOA with low complication and failure rates. Outcomes after TSA for type B glenoid morphology with posterior subluxation were similar to outcomes after TSA for centered type A morphology. Overall patient satisfaction was high and was not influenced by the demographic, anatomic, and surgical variables investigated. III, Therapeutic study, Retrospective Cohort Study.

Le traitement des fractures de l’humérus proximal par prothèse totale d’épaule est plus coûteux en dépense hospitalière malgré une durée de séjour plus courte

BackgroundOperation choice is a complex decision in the surgical management of proximal humerus fractures. Recently, there has been an increase in the use of total shoulder arthroplasty (TSA) for complex fracture patterns. HypothesisPatients with proximal humerus fractures who receive TSA are more likely to have higher hospital charges and a prolonged length of stay relative to patients receiving hemiarthroplasty (HA), open reduction with internal fixation (ORIF) or closed reduction with internal fixation (CRIF). Materials and methodsA statewide electronic database was used to identify 13,316 hospital admissions from 2000–2011 where a proximal humerus fracture was surgically managed in an effort to determine the effect of operation choice on cost and length of stay. A univariate analysis was preformed to examine overall trends in surgical management. Additionally, a periodic, multivariate logistic regression analysis was used to determine how operation choice affected the odds of a high cost hospital stay or a prolonged length of stay after controlling for age, comorbidity burden, gender, and insurance type. ResultsAfter controlling for confounding factors, patients receiving total shoulder arthroplasty (TSA) were 2.25 times more likely to have high total hospital charges than patients receiving HA and 3.21 times more likely than patients receiving ORIF. Additionally, TSA was found to be a significant negative predictor of prolonged length of stay (pLOS). HA, ORIF and CRIF did not significantly predict pLOS. DiscussionThe use of TSA for acute proximal humerus fractures is associated with increased hospital costs despite a shorter length of stay when compared to other operative choices. As reverse total shoulder arthroplasty becomes more popular for treatment of this injury, it is important that functional outcomes be interpreted in the context of relative cost trade-offs. Level of evidenceLevel IV.

Total shoulder arthroplasty for proximal humerus fracture is associated with increased hospital charges despite a shorter length of stay

BackgroundOperation choice is a complex decision in the surgical management of proximal humerus fractures. Recently, there has been an increase in the use of total shoulder arthroplasty (TSA) for complex fracture patterns. HypothesisPatients with proximal humerus fractures who receive TSA are more likely to have higher hospital charges and a prolonged length of stay relative to patients receiving hemiarthroplasty (HA), open reduction with internal fixation (ORIF) or closed reduction with internal fixation (CRIF). Materials and methodsA statewide electronic database was used to identify 13,316 hospital admissions from 2000–2011 were a proximal humerus fracture was surgically managed in an effort to determine the effect of operation choice on cost and length of stay. A univariate analysis was preformed to examine overall trends in surgical management. Additionally, a periodic, multivariate logistic regression analysis was used to determine how operation choice affected the odds of a high cost hospital stay or a prolonged length of stay after controlling for age, comorbidity burden, gender, and insurance type. ResultsAfter controlling for confounding factors, patients receiving total shoulder arthroplasty (TSA) were 2.25 times more likely to have high total hospital charges than patients receiving HA and 3.21 times more likely than patients receiving ORIF. Additionally, TSA was found to be a significant negative predictor of prolonged length of stay (pLOS). HA, ORIF and CRIF did not significantly predict pLOS. DiscussionThe use of TSA for acute proximal humerus fractures is associated with increased hospital costs despite a shorter length of stay when compared to other operative choices. As reverse total shoulder arthroplasty becomes more popular for treatment of this injury, it is important that functional outcomes be interpreted in the context of relative cost trade-offs. Level of evidenceLevel IV.

Age-related differences in the use of total shoulder arthroplasty over time: use and outcomes.

We assessed the age-related differences in the use of total shoulder arthroplasty (TSA) and outcomes, and associated time-trends using the United States Nationwide Inpatient Sample (NIS) between 1998 and 2010. Age was categorised as < 50, 50 to 64, 65 to 79 and ≥ 80 years. Time-trends in the use of TSA were compared using logistic regression or the Cochran Armitage test. The overall use of TSA increased from 2.96/100 000 in 1998 to 12.68/100,000 in 2010. Significantly lower rates were noted between 2009 and 2010, compared with between 1998 and 2000, for: mortality, 0.1% versus 0.2% (p = 0.004); discharge to an inpatient facility, 13.3% versus 14.5% (p = 0.039), and hospital stay > median, 29.4% versus 51.2% (p < 0.001). The rates of use of TSA/100,000 by age groups, < 50, 50 to 64, 65 to 79 and ≥ 80 years were: 0.32, 4.62, 17.82 and 12.56, respectively in 1998 (p < 0.001); and 0.65, 17.49, 75.27 and 49.05, respectively in 2010 (p < 0.001) with an increasing age-related difference over time (p < 0.001). Across the age categories, there were significant differences in the proportion: discharged to an inpatient facility, 3.2% versus 4.2% versus 14.7% versus 36.5%, respectively in 1998 (p < 0.001) and 1.8% versus 4.3% versus 12.5% versus 35.5%, respectively in 2010 (p < 0.001) and the proportion with hospital stay > median, 39.7% versus 40.2% versus 53% versus 69%, respectively in 1998 (p < 0.001) and 17.2% versus 20.6% versus 28.7% versus 50.7%, respectively in 2010 (p < 0.001). In a nationally representative sample, we noted a time-related increase in the use of TSA and increasing age-related differences in outcomes indicating a changing epidemiology of the use of TSA. Age-related differences in outcomes suggest that attention should focus on groups with the worst outcomes.

Management of complications after total shoulder arthroplasty

The outcomes of total shoulder arthroplasty (TSA) for painful arthritis of the glenohumeral joint are excellent with significant improvement in pain and function. Increased use of total shoulder arthroplasty over the past decade has led to identification of common complications. Although the complication rate is low, accurate and timely diagnosis, appropriate management, and implementation of methods for prevention are critical to a successful long-term outcome. The most common complications include infection, glenoid and humeral component loosening, rotator cuff tear, periprosthetic fracture, and neurologic injury. The purpose of this review is to outline the best practices for diagnosing, managing, and preventing these complications.

Shoulder arthroplasty in patients 59 years of age and younger

While shoulder arthroplasty is a well established treatment for a variety of conditions about the shoulder, the results of shoulder replacement in younger patients are not as predictable. The purpose of this study is to examine the indications for shoulder arthroplasty in patients 59 years old and younger, and to analyze revision rates between younger and older patients. This is a retrospective cohort study of shoulder arthroplasties performed within a statewide integrated healthcare system between 2005 and 2010. Patients were stratified into 2 groups based on age at time of index replacement procedure: younger patients (≤59 years) and older patients (>59 years). There were 2981 primary arthroplasties followed for a median time of 2.2 years (interquartile range, 1.0-3.8), 90 (3.0%) of which required revisions. After adjusting for procedure type and diagnosis, younger patients had a two times higher risk (95% CI 1.2-3.5, P = .007) of revision than older patients. When looking at the risk of revision in younger and older patients separately, the risk of revision in hemiarthroplasty (RR = 4.5 vs RR = 1.7) and reverse total shoulder arthroplasty (RR = 33.6 vs RR = 3.0) compared to total shoulder arthroplasty were higher in younger patients compared to older patients. This study suggests patients 59 years and younger have an increased risk of revision at early follow-up. The higher risk of revision in younger patients receiving hemiarthroplasty may support the use of total shoulder arthroplasty in patients 59 years of age and younger.

Treatment of Glenohumeral Osteoarthritis

This clinical practice guideline is based on a systematic review of published studies on the treatment of glenohumeral osteoarthritis in the adult patient population. Of the 16 recommendations addressed, nine are inconclusive. Two were reached by consensus-that physicians use perioperative mechanical and/or chemical venous thromboembolism prophylaxis for shoulder arthroplasty patients and that total shoulder arthroplasty not be performed in patients with glenohumeral osteoarthritis who have an irreparable rotator cuff tear. Four options were graded as weak: the use of injectable viscosupplementation; total shoulder arthroplasty and hemiarthroplasty as treatment; avoiding shoulder arthroplasty by surgeons who perform fewer than two shoulder arthroplasties per year (to reduce the risk of immediate postoperative complications); and the use of keeled or pegged all-polyethylene cemented glenoid components. The single moderate-rated recommendation was for the use of total shoulder arthroplasty rather than hemiarthroplasty. Management of glenohumeral osteoarthritis remains controversial; the scientific evidence on this topic can be significantly improved.

Trends in the epidemiology of total shoulder arthroplasty in the United States from 1990–2000

Longitudinal trends in epidemiology and utilization of total shoulder arthroplasty (TSA) have not been previously reported. We evaluated trends in the distribution of age, race, hospital volume and teaching status, outcomes, and indications for TSA during the last decade. TSA cases (n = 12,758) were extracted from the 1990-2000 Nationwide Inpatient Sample databases. TSA trends were obtained for 3 time periods: 1990-1993 (period I), 1994-1997 (period II), and 1998-2000 (period III). Between 1990 and 2000, there were minor increases in the rate of TSA in most age groups. Ninety-three percent of the patients undergoing TSA in all 3 time periods were white. An increased proportion of patients were operated on in high volume hospitals in period III as compared with period I. Patients discharged to inpatient rehabilitation facilities after surgery had longer lengths of in-hospital stays as compared with those discharged home. Osteoarthritis was diagnosed in an increasing proportion of patients undergoing TSA (56.6% in period I versus 70.9% in period III). There was a minor increase in the rate of TSA, and almost no change in use of TSA by nonwhites from 1990 through 2000. Efforts to understand and narrow this apparent underutilization of TSA among nonwhites are required. Further research should determine whether the observed shift of TSA to high volume centers improves surgical outcomes.