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Baumgarten KM, Max C. Reverse Total Shoulder Arthroplasty Using Lateralized Glenoid Baseplates Has Superior Patient-determined Outcome Scores at Short-term Follow-up. J Am Acad Orthop Surg 2024:00124635-990000000-01044. [PMID: 39018666 DOI: 10.5435/jaaos-d-24-00407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/05/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION There are a variety of baseplate options when performing reverse total shoulder arthroplasty (RTSA). Currently, there is no consensus on the optimal glenoid baseplate. The hypothesis of this study was that the use of lateralized baseplates would improve patient-determined outcomes and postoperative range of motion after RTSA compared with standard baseplates without increasing the risk of complications. METHODS Patients undergoing RTSA were stratified into a standard baseplate group (SBG) and a lateralized baseplate group (LBG). The LBG included 3 mm lateralization, 6 mm lateralization, and full-wedge augmentation (8 mm lateralization). The Western Ontario Osteoarthritis Score, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST) were recorded at baseline, 1 year, and 2 years. Range of motion was recorded at baseline and 1 year. Differences in complications between groups were recorded. RESULTS The LBG included 187 patients, and the SBG included 51 patients. No difference was observed in any patient-determined outcome score at 1-year follow-up. At 2 years, there were greater Western Ontario Osteoarthritis Score (84 ± 16 versus 74 ± 19; P = 0.01), American Shoulder and Elbow Surgeons score (81 ± 15 versus 70 ± 20; P = 0.001), SST (8.0 ± 2.4 versus 6.6 ± 2.6; P = 0.007), and SANE (82 ± 17 versus 68 ± 25; P = 0.0005). The improvement in SST (5.0 ± 2.7 versus 3.3 ± 3.6; P = 0.02) and SANE (54 ± 26 versus 37 ± 30; P = 0.004) at 2 years compared with baseline was greater in the LBG compared with the SBG. No difference was observed in any range-of-motion metric between groups. Total complications were similar between groups (P = 0.91). Scapular notching was more prevalent in the SBG (7.8% versus 1.6%; P = 0.01). CONCLUSION The LBG had better patient-determined outcome scores compared with the SBG at 2-year follow-up with a similar rate of overall complications but a lower rate of scapular notching. Range of motion was not improved by the use of a lateralized baseplate compared with a standard baseplate.
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Affiliation(s)
- Keith M Baumgarten
- From the Orthopedic Institute, Sioux Falls, South Dakota, and the Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
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Okutan AE, Surucu S, Laprus H, Raiss P. The lateralization and distalization index is more reliable than angular radiographic measurements in reverse shoulder arthroplasty. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05448-6. [PMID: 39008078 DOI: 10.1007/s00402-024-05448-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND The lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) are used to reproducibly measure lateralization and distalization after reverse shoulder arthroplasty (RSA). However, LSA and DSA may not offer a precise measurement of humeral lateralization and distalization and this relationship has not been explored. The aim of this study was to evaluate the validity of these measurements and to propose new measurement methods to estimate implant lateralization and distalization. METHODS 3D models were constructed from computed tomography (CT) scans of 30 patients using a software platform. For each patient 24 different RSA modifications were created, resulting in 720 different RSA configurations. For each configuration LSA and DSA angles as well as lateralization and distalization distances were measured. Moreover, for each configuration two new measurements were done: the lateralization index (LI) and distalization index (DI). Correlations of the lateralization and distalization parameters were evaluated between measurements. RESULTS Weak correlations were founded between LSA and lateralization (r = 0.36, p < 0.01), whereas moderate correlations were observed between LI and lateralization (r = 0.72, p < 0.01). No significant correlations were found between DSA and distalization (r = 0.17, p = 0.113). In contrast, moderate correlations were identified between DI and distalization (r = 0.69, p < 0.01). CONCLUSION LI and DI are more reliable methods to estimate implant lateralization and distalization compared to angular radiographic measurements. However, the prognostic significance in predicting clinical outcomes after RSA remains unknown.
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Affiliation(s)
- Ahmet Emin Okutan
- Department of Orthopaedic Surgery, Samsun University School of Medicine, Samsun, Turkey.
| | - Serkan Surucu
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, USA
| | | | - Patric Raiss
- Orthopadische Chirurgie Munchen, Munich, Germany
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Clinker C, Ishikawa H, Presson AP, Zhang C, Joyce C, Chalmers PN, Tashjian RZ. The effect of lateralization and distalization after Grammont-style reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2024:S1058-2746(24)00348-3. [PMID: 38754540 DOI: 10.1016/j.jse.2024.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/10/2024] [Accepted: 03/25/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The purpose of this study was to evaluate the relationship between multiple radiographic measures of lateralization and distalization and clinical outcome scores after a reverse total shoulder arthroplasty (RTSA). METHODS We retrospectively evaluated all RTSAs performed by the senior author between January 1, 2007, and November 1, 2017. We then evaluated the visual analog scale for pain (VAS pain), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) scores and complication and reoperation rates at a minimum of 2-year follow-up. We measured preoperative and postoperative (2-week) radiographs for the lateralization shoulder angle (LSA), the distalization shoulder angle (DSA), lateral humeral offset, and the distance from the glenoid to the lateral aspect of the greater tuberosity. A multivariable analysis was performed to evaluate the effect of the postoperative radiographic measurements on final patient-reported outcomes (ASES scores, SST, and VAS pain). RESULTS The cohort included 216 shoulders from unique patients who had patient-reported outcome scores available at a minimum of 2-year follow-up (average, 4.0 ± 1.9 years) for a total follow-up rate of 70%. In the multivariable models, more lateralization (LSA) was associated with worse final ASES scores -0.52 (95% confidence interval [CI]: -0.88, -0.17; P = .004), and more distalization (DSA) was associated with better final ASES scores 0.40 (95% CI: 0.11, 0.69; P = .007). More lateralization (LSA) was associated with worse final SST scores -0.06 (95% CI: -0.11, -0.003; P = .039). Finally, greater distalization (DSA) was associated with lower final VAS pain scores, ratio = 0.98 (95% CI: 0.96, 1.00; P = .021). CONCLUSIONS Greater distalization and less lateralization are associated with better function and less pain after a Grammont-style RTSA. When using a Grammont-style implant, remaining consistent with Grammont's principles of implant placement will afford better final clinical outcomes.
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Affiliation(s)
- Chris Clinker
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Hiroaki Ishikawa
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Christopher Joyce
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
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Schippers P, Lacouture JD, Junker M, Baranowski A, Drees P, Gercek E, Boileau P. Can we separately measure glenoid vs. humeral lateralization and distalization in reverse shoulder arthroplasty? J Shoulder Elbow Surg 2024; 33:1169-1176. [PMID: 37890767 DOI: 10.1016/j.jse.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/28/2023] [Accepted: 09/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Lateralization and distalization in reverse shoulder arthroplasty (RSA) can be measured on anteroposterior (AP) radiographs using 2 previously described angles: lateralization shoulder angle (LSA) and distalization shoulder angle (DSA). However, these 2 angles measure global lateralization and distalization but do not allow to differentiate how much lateralization or distalization are attributable to the glenoid and the humerus. We hypothesized that new angles could allow us to separately measure glenoid vs. humeral lateralization and distalization. A more precise understanding of independent glenoid and humeral contributions to lateralization and distalization may be beneficial in subsequent clinical research. METHOD Retrospective analysis of postoperative AP radiographs of 100 patients who underwent primary RSA for cuff-tear arthropathy, massive cuff tear, or glenohumeral osteoarthritis were analyzed. The new angles that we proposed use well-known bony landmarks (the acromion, glenoid, and humerus) and the most lateral point of the glenosphere, which we termed the "glenoid pivot point" (GPP). For lateralization, we used the GPP to split LSA into 2 new angles: glenoid lateralization angle (GLA) and humeral lateralization angle (HLA). For distalization, we introduced the modified distalization shoulder angle (mDSA) that can also be split into 2 new angles: glenoid distalization angle (GDA) and humeral distalization angle (HDA). Three orthopedic surgeons measured the new angles, using the online tool Tyche. Mean values with overall and individual standard deviations as well as intraclass correlation coefficients (ICCs) were calculated. RESULTS Because the angles form a triangle, the following equations can be made: LSA = GLA + HLA, and mDSA = GDA + HDA. All angles showed excellent inter- and intraobserver reliability (ICC = 0.92-0.97) with low means of individual standard deviations that indicate a precision of 2° for each angle. CONCLUSION Use of the most lateral part of the glenosphere (termed glenoid pivot point) allows us to separately measure glenoid vs. humeral lateralization and distalization. The 4 new angles (HLA, GLA, GDA, HDA) described in the present study can be used on true AP radiographs, routinely obtained after shoulder replacement, and the measured angles may be used with all types of reverse prostheses available.
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Affiliation(s)
- Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | | | - Marius Junker
- Department of Orthopedics, Tabea Hospital, Hamburg, Germany
| | - Andreas Baranowski
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Philipp Drees
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Erol Gercek
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Pascal Boileau
- Institute for Sports & Reconstructive Surgery (ICR), Nice, France
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Waheed I, Ediripolage F, Alvi I, Haider JM. Preoperative Risk Factors for Pain After Reverse Total Shoulder Arthroplasty: A Systematic Review. Cureus 2024; 16:e60041. [PMID: 38736766 PMCID: PMC11087139 DOI: 10.7759/cureus.60041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 05/14/2024] Open
Abstract
Despite being a generally successful procedure, pain following reverse total shoulder arthroplasty (rTSA) is a known complication. The aim of this systematic review is to identify preoperative risk factors for pain following rTSA to encourage evidence-based interventions, inform clinicians, and aid in surgical planning. Studies that reported preoperative risk factors and pain after rTSA were included. Studies which reported outcome measures that incorporated pain scores yet did not display them independently, studies which only reported intraoperative risk factors, and studies involving participants under 18 were excluded. The search was conducted on May 31, 2023, across the following databases: PubMed, Web of Science, Embase, Scopus, and Cochrane Central Register of Controlled Trials. Four independent researchers conducted this systematic review, and a descriptive analysis was subsequently performed. Twenty-five studies were included following the evaluation of full-text articles, involving a total of 9,470 shoulders. Preoperative risk factors identified were categorised into the following groups: BMI, smoking, radiographic findings, age and sex, prior surgery, functional ability and pain, and psychosocial. The strongest associations identified were preoperative opioid use and smoking, which were both associated with worse pain outcomes following rTSA; other preoperative risk factors highlighted in this review showed either weak or no correlation. Preoperative opioid use and smoking are likely risk factors for the development of pain after rTSA. Although the studies included varying levels of quality, the identification of modifiable risk factors is useful in optimising management prior to surgery and guiding patient expectations. The lack of evidence regarding associations with non-modifiable risk factors further reinforces the potential benefits of the procedure on diverse population groups and is useful in itself for assessing the candidacy of patients for the procedure, particularly when postoperative pain is a factor being considered.
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Affiliation(s)
- Isa Waheed
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, GBR
| | - Fenu Ediripolage
- Department of Urology, St George's University Hospitals NHS Foundation Trust, London, GBR
| | - Isaamuddin Alvi
- Department of General Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
| | - Jawwad Mihran Haider
- Department of General Surgery, Chelsea and Westminster Hospital NHS Trust, London, GBR
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Spek RW, Hoogervorst LA, Brink RC, Schoones JW, van Deurzen DF, van den Bekerom MP. Ten technical aspects of baseplate fixation in reverse total shoulder arthroplasty for patients without glenoid bone loss: a systematic review. Clin Shoulder Elb 2024; 27:88-107. [PMID: 38147872 PMCID: PMC10938023 DOI: 10.5397/cise.2023.00493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 12/28/2023] Open
Abstract
The aim of this systematic review was to collect evidence on the following 10 technical aspects of glenoid baseplate fixation in reverse total shoulder arthroplasty (rTSA): screw insertion angles; screw orientation; screw quantity; screw length; screw type; baseplate tilt; baseplate position; baseplate version and rotation; baseplate design; and anatomical safe zones. Five literature libraries were searched for eligible clinical, cadaver, biomechanical, virtual planning, and finite element analysis studies. Studies including patients >16 years old in which at least one of the ten abovementioned technical aspects was assessed were suitable for analysis. We excluded studies of patients with: glenoid bone loss; bony increased offset-reversed shoulder arthroplasty; rTSA with bone grafts; and augmented baseplates. Quality assessment was performed for each included study. Sixty-two studies were included, of which 41 were experimental studies (13 cadaver, 10 virtual planning, 11 biomechanical, and 7 finite element studies) and 21 were clinical studies (12 retrospective cohorts and 9 case-control studies). Overall, the quality of included studies was moderate or high. The majority of studies agreed upon the use of a divergent screw fixation pattern, fixation with four screws (to reduce micromotions), and inferior positioning in neutral or anteversion. A general consensus was not reached on the other technical aspects. Most surgical aspects of baseplate fixation can be decided without affecting fixation strength. There is not a single strategy that provides the best outcome. Therefore, guidelines should cover multiple surgical options that can achieve adequate baseplate fixation.
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Affiliation(s)
- Reinier W.A. Spek
- Department of Orthopaedic Surgery, Flinders University and Flinders Medical Center, Adelaide, Australia
- Department of Orthopaedic Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lotje A. Hoogervorst
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomedical Data Sciences and Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob C. Brink
- Department of Orthopaedic Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
| | - Jan W. Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Michel P.J. van den Bekerom
- Department of Orthopaedic Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
- Shoulder and Elbow Expertise Center, Amsterdam, the Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Stenson JF, Mills ZD, Dasari SP, Whitson AJ, Hsu JE, Matsen FA. Managing rotator cuff tear arthropathy: a role for cuff tear arthropathy hemiarthroplasty as well as reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:e162-e174. [PMID: 37473904 DOI: 10.1016/j.jse.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Disabling cuff tear arthropathy (CTA) is commonly managed with reverse shoulder arthroplasty (RSA). However, for patients with CTA having preserved active elevation, cuff tear arthropathy hemiarthroplasty (CTAH) may offer a cost-effective alternative that avoids the complications unique to RSA. We sought to determine the characteristics and outcomes of a series of patients with CTA managed with these procedures. MATERIALS AND METHODS We retrospectively reviewed 103 patients with CTA treated with shoulder arthroplasty, the type of which was determined by the patient's ability to actively elevate the arm. Outcome measures included the change in the Simple Shoulder Test (SST), the percent maximum improvement in SST (%MPI), and the percentage of patients exceeding the minimal clinically important difference for the change in SST and %MPI. Postoperative x-rays were evaluated to assess the positions of the center of rotation and the greater tuberosity for each implant. RESULTS Forty-four percent of the 103 patients were managed with CTAH while 56% were managed with RSA. Both arthroplasties resulted in clinically significant improvement. Patients having RSA improved from a mean preoperative SST score of 1.7 (interquartile range [IQR], 0.0-3.0) to a postoperative score of 6.3 (IQR, 2.3-10.0) (P < .01). Patients having CTAH improved from a preoperative SST score of 3.1 (IQR, 1.0-4.0) to a postoperative score of 7.6 (IQR, 5.0-10.) (P < .001). These improvements exceeded the minimal clinically important difference. Instability accounted for most of the RSA complications; however, it did not account for any CTAH complications. The postoperative position of the center of rotation and greater tuberosity on anteroposterior radiographs did not correlate with the clinical outcomes for either procedure. CONCLUSION For 103 patients with CTA, clinically significant improvement was achieved with appropriately indicated CTAH and RSA. In view of the lower cost of the CTAH implant, it may provide a cost-effective alternative to RSA for patients with retained active elevation.
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Affiliation(s)
- James F Stenson
- Orthopedic Surgery, Einstein Healthcare Network, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Zachary D Mills
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Suhas P Dasari
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Anastasia J Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA.
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Dainotto T, Gómez D, Ernst G. Can Distalisation and Lateralisation Shoulder Angles in Reverse Arthroplasty Interfere with the Functional Results in Patients with Rotator Cuff Arthropathy? Rev Bras Ortop 2024; 59:e93-e100. [PMID: 38524722 PMCID: PMC10957274 DOI: 10.1055/s-0044-1779609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/18/2023] [Indexed: 03/26/2024] Open
Abstract
Objective: To evaluate the influence of radiographic values on clinical and functional results in patients treated with reverse arthroplasty for rotator cuff arthropathy (RCA) using a lateralized design. Methods: A retrospective analysis was performed. Patient demographics were recorded, as well as preoperative and postoperative range of motion. Function was calculated using the Constant-Murley score both before and after the procedure. Pre and postoperative anteroposterior and axial radiographs of the affected shoulder were analysed. In the preoperative images, the following was calculated: acromiohumeral distance (AHD) and lateral humeral offset (LHO). Postoperative measurements included: AHD, LHO, distalization shoulder angle (DSA) and lateralisation shoulder angle (LSA). Linear regression and quadratic regression analysis was performed to determine their degree of association with final functional outcomes. By applying a quadratic regression analysis and ROC curves, the cut-off values were determined with respect to the above-mentioned angles and the positive predictive value was calculated. Results: The greater anterior elevation (AE) ranges were found with DSA between 40-45° and LSA among 80°- 90°, while better ABD was observed with LSA of 90-100°. Preoperative AHD was correlated to RE (r s :0.47; p:0.049). Postoperative AHD was found to be in a directly proportional relationship with AE (r s :0.49; p:0.03). Postoperative ABD showed an inverse linear regression with preoperative AHD (r s : -0.44, p:0.047). LSA and DSA were inversely related. Conclusion: We found that a DSA between 40-45° and a LSA of 80-100° could lead to better range of motion regarding AE and ABD in patients with rotator cuff arthropathy treated with RSA.
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Affiliation(s)
- Tamara Dainotto
- Departamento deOrtopedia e Traumatologia, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Diego Gómez
- Departamento deOrtopedia e Traumatologia, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Glenda Ernst
- Conselho Científico, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
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Imiolczyk JP, Imiolczyk T, Góralczyk A, Scheibel M, Freislederer F. Lateralization and distalization shoulder angles do not predict outcomes in reverse shoulder arthroplasty for cuff tear arthropathy. J Shoulder Elbow Surg 2024; 33:121-129. [PMID: 37414355 DOI: 10.1016/j.jse.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND In reverse shoulder arthroplasty (RSA), there are a plethora of measurements regarding implant lateralization and distalization to optimize the center of rotation. Two specific measurements known as the "lateralization shoulder angle" (LSA) and "distalization shoulder angle" (DSA) have been the recent focus of studies to assess their association with RSA and postoperative function. The aim of this study was to evaluate the prognostic clinical value of the LSA and DSA in a large cohort of patients with cuff tear arthropathy (CTA) who were treated with different RSA systems. METHODS Two local shoulder arthroplasty registries were reviewed for all RSA patients documented to have undergone a radiologic assessment and complete 2-year follow-up examination. The main inclusion criterion was primary RSA in patients with CTA. Patients with either a complete teres minor tear, os acromiale, or acromial stress fracture reported between the time of surgery and the 24-month follow-up were excluded. Five RSA implant systems with 4 neck-shaft angles (NSAs) were assessed. The Constant score, Subjective Shoulder Value, and range of motion at 2 years were correlated with both the LSA and DSA assessed on 6-month anteroposterior radiographs. Linear and parabolic univariable regressions were calculated for both shoulder angles, for each prosthesis system, and for the entire patient cohort. RESULTS Between May 2006 and November 2019, there were a total of 630 CTA patients who had undergone primary RSA. Of this large cohort of patients, 270 were treated with the Promos Reverse prosthesis system (NSA, 155°); 44, Aequalis Reversed II (NSA, 155°); 62, Lima SMR Reverse (NSA, 150°); 25, Aequalis Ascend Flex (NSA, 145°); and 229, Univers Revers (NSA, 135°). The mean LSA was 78° (standard deviation [SD], 10°; range, 6°-107°), and the mean DSA was 51° (SD, 10°; range, 7°-91°). The average Constant score at 24 months' follow-up was 68.1 points (SD, 13 points; range, 13-96 points). Neither the linear nor parabolic regression calculations for the LSA or DSA revealed significant associations with any of the clinical outcomes. CONCLUSION Different patients may achieve different clinical outcomes despite having identical LSA and DSA values. There is no association between angular radiographic measurements and 2-year functional outcomes after RSA.
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Affiliation(s)
- Jan-Philipp Imiolczyk
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Tankred Imiolczyk
- Department for Mathematics, University of Mannheim, Mannheim, Germany
| | - Adrian Góralczyk
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany; Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Florian Freislederer
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland.
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Longo UG, Franceschetti E, Carnevale A, Schena E, Cozza G, Perricone G, Cardinale ME, Papalia R. Influence of Lateralization and Distalization on Joint Function after Primary Reverse Total Shoulder Arthroplasty. Bioengineering (Basel) 2023; 10:1409. [PMID: 38136000 PMCID: PMC10740542 DOI: 10.3390/bioengineering10121409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
The purpose of this study was to investigate how lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) are related to clinical and kinematic outcomes after reverse total shoulder arthroplasty. Thirty-three patients were evaluated at least six months postoperatively. The Single Assessment Numeric Evaluation (SANE), Constant Murley Score (CMS), Simple Shoulder Test (SST), and Visual Analogue Scale (VAS) were used. Shoulder kinematics was evaluated with a stereophotogrammetric system. LSA and DSA inter-rater reliability was analysed through the interclass correlation coefficient (ICC). Stepwise forward linear regression analysis was conducted between LSA and DSA with clinical scales and kinematic measures, between which a correlation analysis was conducted. The inter-rater reliability for LSA (mean ICC = 0.93) and DSA (mean ICC = 0.97) results were good to excellent. Greater LSA values were associated with higher peaks of internal rotation (p = 0.012, R2 = 0.188) and range of motion (ROM) (p = 0.037, R2 = 0.133). SANE (p = 0.009), CMS (p = 0.031), and SST (0.026) were positively correlated to external rotation, while VAS (p = 0.020) was negatively related. Abduction peaks were positively related to CMS (p = 0.011) and SANE (p = 0.037), as well as abduction ROM (SANE, p = 0.031; CMS, p = 0.014).
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Edoardo Franceschetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Arianna Carnevale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
| | - Emiliano Schena
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Laboratory of Measurement and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Giulia Cozza
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
| | - Giovanni Perricone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Marco Edoardo Cardinale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
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Hochreiter B, Selman F, Calek AK, Kriechling P, Götschi T, Grubhofer F, Wieser K, Bouaicha S. Why is female gender associated with poorer clinical outcomes after reverse total shoulder arthroplasty? J Shoulder Elbow Surg 2023; 32:2355-2365. [PMID: 37276918 DOI: 10.1016/j.jse.2023.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION There is a lack of gender-specific research after reverse total shoulder arthroplasty (RTSA). Although previous studies have documented worse outcomes in women, a more thorough understanding of why outcomes may differ is needed. We therefore asked: (1) Are there gender-specific differences in preoperative and postoperative clinical scores, complications, surgery-related parameters, and demographics? (2) Is female gender an independent risk factor for poorer clinical outcomes after RTSA? (3) If so, why is female gender associated with poorer outcomes after RTSA? MATERIALS AND METHODS Between 2005 and 2019, 987 primary RTSAs were performed in our institution. After exclusion criteria were applied, data of 422 female and 271 male patients were analyzed. Clinical outcomes (absolute/relative Constant Score [a/rCS] and Subjective Shoulder Value [SSV]), complications (intra- and/or postoperative fracture, loosening), surgery-related parameters (indication, implant-related characteristics), and demographics (age, gender, body mass index, and number of previous surgeries) were evaluated. Preoperative and postoperative radiographs were analyzed (critical shoulder angle, deltoid-tuberosity index, reverse shoulder angle, lateralization shoulder angle, and distalization shoulder angle). RESULTS Preoperative clinical scores (aCS, rCS, SSV, and pain level) and postoperative clinical outcomes (aCS and rCS) were significantly worse in women. However, the improvement between preoperative and postoperative outcomes was significantly higher in female patients for rCS (P = .037), internal rotation (P < .001), and regarding pain (P < .001). Female patients had a significantly higher number of intraoperative and postoperative fractures (24.9% vs. 11.4%, P < .001). The proportion of female patients with a deltoid-tuberosity index <1.4 was significantly higher than males (P = .01). Female gender was an independent negative predictor for postoperative rCS (P = .047, coefficient -0.084) and pain (P = .017, coefficient -0.574). In addition to female sex per se being a predictive factor of worse outcomes, females were significantly more likely to meet 2 of the 3 most significant predictive factors: (1) significantly worse preoperative clinical scores and (2) higher rate of intra- and/or postoperative fractures. CONCLUSIONS Female sex is a very weak, but isolated, negative predictive factor that negatively affects the objective clinical outcome (rCS) after RTSA. However, differences did not reach the minimal clinically important difference, and it is not a predictor for the subjective outcome (SSV). The main reason for the worse outcome in female patients seems to be a combination of higher preoperative disability and higher incidence of fractures. To improve the outcome of women, all measures that contribute to the reduction of perioperative fracture risk should be used.
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Affiliation(s)
- Bettina Hochreiter
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Farah Selman
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Kriechling
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian Grubhofer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Samy Bouaicha
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Haeffner BD, Cueto RJ, Abdelmalik BM, Hones KM, Wright JO, Srinivasan RC, King JJ, Wright TW, Werthel JD, Schoch BS, Hao KA. The association between humeral lengthening and clinical outcomes after reverse shoulder arthroplasty: a systematic review and meta-analysis. J Shoulder Elbow Surg 2023; 32:e477-e494. [PMID: 37379967 DOI: 10.1016/j.jse.2023.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/04/2023] [Accepted: 05/13/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the relationship between humeral lengthening and clinical outcomes after reverse shoulder arthroplasty (RSA) with stratification based on measurement method and implant design. METHODS This systematic review was performed using PRISMA-P guidelines. PubMed/Medline, Cochrane Trials, and Embase were queried for articles evaluating the relationship between humeral lengthening and clinical outcomes inclusive of range of motion (ROM), strength, outcome scores, and pertinent complications (acromial and scapular spine fractures, nerve injury) after RSA. The relationship between humeral lengthening and clinical outcomes was reported descriptively overall and stratified by measurement method and implant design (globally medialized vs. lateralized). A positive association was defined as increased humeral lengthening being associated with greater ROM, outcome scores, or a greater incidence of complications, whereas a negative association denoted that increased humeral lengthening was associated with poorer ROM, outcome scores, or a lower incidence of complications. Meta-analysis was performed to compare humeral lengthening between patients with and without fractures of the acromion or scapular spine. RESULTS Twenty-two studies were included. Humeral lengthening was assessed as the acromiohumeral distance (AHD), the distance from the acromion to the greater tuberosity (AGT), the acromion to the deltoid tuberosity (ADT), and the acromion to the distal humerus (ADH). Of 11 studies that assessed forward elevation, a positive association with humeral lengthening was found in 6, a negative association was found in 1, and 4 studies reported no association. Of studies assessing internal rotation (n = 9), external rotation (n = 7), and abduction (n = 4), all either identified a positive or lack of association with humeral lengthening. Studies assessing outcome scores (n = 11) found either a positive (n = 5) or no (n = 6) association with humeral lengthening. Of the studies that assessed fractures of the acromion and/or scapular spine (n = 6), 2 identified a positive association with humeral lengthening, 1 identified a negative association, and 3 identified no association. The single study that assessed the incidence of nerve injury identified a positive association with humeral lengthening. Meta-analysis was possible for AGT (n = 2) and AHD (n = 2); greater humeral lengthening was found in patients with fractures for studies using the AGT (mean difference 4.5 mm, 95% CI 0.7-8.3) but not the AHD. Limited study inclusion and heterogeneity prohibited identification of trends based on method of measuring humeral lengthening and implant design. CONCLUSION The relationship between humeral lengthening and clinical outcomes after RSA remains unclear and requires future investigation using a standardized assessment method.
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Affiliation(s)
- Brett D Haeffner
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Robert J Cueto
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Keegan M Hones
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | | | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | | | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
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Rojas J, Lievano, Jiménez AM, González-Rico HA, Salas M, Fierro G, González JC. Preoperative planning in reverse shoulder arthroplasty: plain radiographs vs. computed tomography scan vs. navigation vs. augmented reality. ANNALS OF JOINT 2023; 8:37. [PMID: 38529225 PMCID: PMC10929295 DOI: 10.21037/aoj-23-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/11/2023] [Indexed: 03/27/2024]
Abstract
Reverse shoulder arthroplasty (RSA) has become a highly successful treatment option for various shoulder conditions, leading to a significant increase in its utilization since its approval in 2003. However, postoperative complications, including scapular notching, prosthetic instability, and component loosening, remain a concern. These complications can often be attributed to technical errors during component implantation, emphasizing the importance of proper preoperative planning and accurate positioning of prosthetic components. Improper baseplate and glenosphere positioning in RSA have been linked to impingement, reduced range of motion, and increased scapular notching. Additionally, the relationship between component positioning and intrinsic stability of RSA has been established, with glenoid component retroversion exceeding 10° posing a risk to implant stability. Adequate initial glenoid baseplate fixation, achieved through optimal seating and the use of appropriate screws, is crucial for long-term success and prevention of early failure. Factors such as lateralization and distalization also influence outcomes and complications in RSA, yet standardized guidelines for preoperative planning in these parameters are still lacking. Despite the impact of component position on outcomes, glenoid component implantation remains challenging, with position errors being common even among experienced surgeons. Challenges arise due to factors such as deformity, bone defects, limited exposure, and the absence of reliable bony landmarks intraoperatively. With the evolving understanding of RSA biomechanics and the significance of implant configuration and positioning, advancements in preoperative planning and surgical aids have emerged. This review article explores the current evidence on preoperative planning techniques in RSA, including plain radiographs, three-dimensional imaging, computer planning software, intraoperative navigation, and augmented reality (AR), highlighting their potential benefits and advancements in improving implant position accuracy.
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Affiliation(s)
- Jorge Rojas
- Division of Shoulder and Elbow Surgery, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Lievano
- Division of Shoulder and Elbow Surgery, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Andrés Mauricio Jiménez
- Division of Shoulder and Elbow Surgery, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Helberth Augusto González-Rico
- Division of Shoulder and Elbow Surgery, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Mercedes Salas
- Division of Shoulder and Elbow Surgery, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Guido Fierro
- Division of Shoulder and Elbow Surgery, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Juan Carlos González
- Division of Shoulder and Elbow Surgery, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
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Postoperative acromiohumeral interval affects shoulder range of motions following reverse total shoulder arthroplasty. Sci Rep 2022; 12:21011. [PMID: 36470933 PMCID: PMC9722688 DOI: 10.1038/s41598-022-25173-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
Reverse total shoulder arthroplasty (RTSA) improves function and reduces pain for patients with complex shoulder problems. However, there is a lack of literature regarding the association of radiographic parameters on clinical outcomes after RTSA. The aim of this study was to analyze various radiographic parameters that may be predictive of clinical outcomes after RTSA. A total of 55 patients treated with RTSA were enrolled. Shoulder radiographic parameters were used for measurement of critical shoulder angle, acromial index, acromiohumeral interval, deltoid lever arm, acromial angulation, glenoid version, and acromial height. Preoperative and postoperative clinical outcomes were evaluated at a minimum 2-year follow-up. An analysis of correlations between radiographic parameters and clinical outcomes was then performed. A significant change in critical shoulder angle, acromiohumeral interval, and deltoid lever arm was observed between preoperative and postoperative radiographic measurements. A significant improvement was observed in all clinical outcomes and range of motions from preoperative to postoperative (all p < 0.001). A negative correlation of postoperative acromiohumeral interval with forward flexion (r = - 0.270; p = 0.046), external rotation (r = - 0.421; p = 0.001), and internal rotation (r = 0.275; p = 0.042) was observed at final follow-up. In addition, postoperative acromiohumeral interval less than 29 mm had an 86% positive predictive value of obtaining 130° of forward flexion and 45° of external rotation. It was found that postoperative acromiohumeral interval showed an association with active range of motion in patients who underwent RTSA. In particular, excessive distalization reduced forward flexion and external rotation motion of the shoulder in patients treated with RTSA.
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Baumgarten KM. Can the Single Assessment Numeric Evaluation (SANE) be used as a stand-alone outcome instrument in patients undergoing total shoulder arthroplasty? J Shoulder Elbow Surg 2022; 31:e426-e435. [PMID: 35413432 DOI: 10.1016/j.jse.2022.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS There is no consensus as to which patient-determined shoulder outcome scores should be considered when analyzing patient outcomes for either clinical or research purposes. Use of multiple patient-determined outcomes may be redundant and cause increased responder burden. To date, the Single Assessment Numeric Evaluation (SANE) has not been widely accepted as a stand-alone shoulder-specific outcome measure. The hypothesis of this study was that the SANE would correlate with and be equal or superior in responsiveness to other outcome measures that have been used in a stand-alone fashion in patients undergoing total shoulder arthroplasty (American Shoulder and Elbow Surgeons [ASES], Western Ontario Osteoarthritis of the Shoulder [WOOS], and Simple Shoulder Test [SST] scores). In addition, it was hypothesized that the SANE would be more relevant to each patient than the ASES assessment, further supporting the use of the SANE as a stand-alone shoulder-specific outcome measure. METHODS A retrospective review of a database of patients undergoing total shoulder arthroplasty was performed, in which the SANE score was recorded simultaneously with the ASES, WOOS, and/or SST score. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine whether correlations differed in (1) preoperative outcome and (2) postoperative outcome determinations. Responsiveness was determined by calculating the standardized response mean and the effect size of all scores. The relevance of the SANE and ASES assessments was examined using the scores of 150 consecutive patients to determine the number of questions on each assessment that were not answered. RESULTS Correlation was excellent for the SANE score and the ASES score (n = 1447, r = 0.82, P < .0001), WOOS score (n = 1514, r = 0.83, P < .0001), and SST score (n = 1095, r = 0.81, P < .0001). The correlation of preoperative scores was moderate and that of postoperative scores was strong-moderate when the SANE score was compared with all 3 other scores. All scores were highly responsive, with standardized response mean values of 2.2 for the SANE score, 2.3 for the ASES score, 1.4 for the WOOS score, and 1.6 for the SST score. The effect size of the SANE score was 2.9; ASES score, 2.9; WOOS score, 2.9; and SST score, 2.3. One hundred percent of the SANE questions were answered completely compared with 61% of the ASES questions (P < .0001). CONCLUSION In patients undergoing total shoulder arthroplasty, the SANE score highly correlated with the WOOS, ASES, and SST scores, which have been used as stand-alone shoulder-specific outcome measures. The SANE score may provide the same information as the WOOS, ASES, and SST score regarding outcomes with a significant reduction in responder burden. It is logical that the SANE can be used as a stand-alone instrument for patients undergoing total shoulder arthroplasty.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA.
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PCDM and PCDM4MP: New Pairwise Correlation-Based Data Mining Tools for Parallel Processing of Large Tabular Datasets. MATHEMATICS 2022. [DOI: 10.3390/math10152671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The paper describes PCDM and PCDM4MP as new tools and commands capable of exploring large datasets. They select variables based on identifying the absolute values of Pearson’s pairwise correlation coefficients between a chosen response variable and any other existing in the dataset. In addition, for each pair, they also report the corresponding significance and the number of non-null intersecting observations, and all this reporting is performed in a record-oriented manner (both source and output). Optionally, using threshold values for these three as parameters of PCDM, any user can select the most correlated variables based on high magnitude, significance, and support criteria. The syntax is simple, and the tools show the exploration progress in real-time. In addition, PCDM4MP can trigger different instances of Stata, each using a distinct class of variables belonging to the same dataset and resulting after simple name filtering (first letter). Moreover, this multi-processing (MP) version overcomes the parallelization limitations of the existing parallel module, and this is accomplished by using vertical instead of horizontal partitions of large flat datasets, dynamic generation of the task pattern, tasks, and logs, all within a single execution of this second command, and the existing qsub module to automatically and continuously allocate the tasks to logical processors and thereby emulating with fewer resources a cluster environment. In addition, any user can perform further selections based on the results printed in the console. The paper contains examples of using these tools for large datasets such as the one belonging to the World Values Survey and based on a simple variable naming practice. This article includes many recorded simulations and presents performance results. They depend on different resources and hardware configurations used, including cloud vs. on-premises, large vs. small amounts of RAM and processing cores, and in-memory vs. traditional storage.
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