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Patel AV, White CA, Li T, Parsons BO, Flatow EL, Cagle PJ. Glenosphere Size Does Not Matter in Reverse Total Shoulder Arthroplasty. Rev Bras Ortop 2024; 59:e254-e259. [PMID: 38606143 PMCID: PMC11006517 DOI: 10.1055/s-0043-1770976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/24/2023] [Indexed: 04/13/2024] Open
Abstract
Objective There are few studies to date reporting on outcomes following reverse total shoulder arthroplasty with cohorts stratified by glenosphere size. The purpose of this study is to investigate the role that glenosphere size has on postoperative outcomes. Methods Patients who underwent reverse TSA between 1987 with minimum of 2.0 years of follow-up were included. Patients were stratified into two cohorts based on glenosphere size of 36mm or 40mm. Patients' range of motion, patient-reported outcomes, and radiographic variables (glenoid preoperative morphology, scapular notching, humeral loosening) were evaluated. Results All measurements of range of motion measurements with the exception of internal rotation saw significant preoperative to postoperative improvements within each cohort. There were no significant differences in postoperative range of motion, ASES, or VAS pain scores across the two cohorts. Overall, forward elevation improved to 134° ± 16° in the 36mm cohort and 133° ± 14° in the 40mm cohort ( p = 0.47). External rotation improved to 37° ± 13° for 36mm patients and 35° ± 19° for 40mm patients ( p = 0.58). In the 36mm group, internal rotation increased by 1.3 vertebral levels and 2.3 vertebral levels in the 40mm cohort. At final follow-up, the 36mm cohort had a VAS score of 2 ± 2, ASES score of 66 ± 19, and SST score of 6 ± 3. Similarly, the 40mm cohort had a VAS score of 2 ± 3, ASES score of 77 ± 28, and SST score of 9 ± 3. Conclusions Reverse TSA provides sustained improvements in range of motion and shoulder function irrespective of glenosphere size. Level of Evidence III.
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Affiliation(s)
- Akshar V. Patel
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Christopher A. White
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Troy Li
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Bradford O. Parsons
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Evan L. Flatow
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Paul J. Cagle
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
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Duey AH, Stern BZ, Zubizarreta N, Galatz LM, Parsons BO, Poeran J, Cagle PJ. Surgical Treatment of Displaced Proximal Humerus Fractures Is Associated With Decreased 1-Year Mortality in Patients Aged 65 and Older: A Retrospective Study of Medicare Patients. J Shoulder Elbow Surg 2024:S1058-2746(24)00154-X. [PMID: 38430980 DOI: 10.1016/j.jse.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/01/2024] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Proximal humerus fracture (PHF) is a risk factor for 1-year mortality. This study aimed to determine if surgery is associated with lower mortality compared to nonoperative treatment following PHF in older patients. METHODS This retrospective cohort study used the Medicare Limited Data Set. Patients aged 65+ with a PHF diagnosis in 2017-2020 were included. Treatment was classified as nonoperative, open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), or hemiarthroplasty. Multivariable logistic regression models examined (a) predictors of treatment type and (b) the association of treatment type with 1-year mortality, adjusting for patient demographics, comorbidities, frailty, and fracture severity among other variables. A subgroup analysis examined how the relationship between treatment type and 1-year mortality varied based on fracture severity. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. RESULTS In total, 49,072 patients were included (mean age = 76.6 years, 82.3% female). Most were treated nonoperatively (77.5%), 10.9% underwent ORIF, 10.6% underwent TSA, and 1.0% underwent hemiarthroplasty. Examples of factors associated with receipt of operative (versus nonoperative treatment) included worse fracture severity and lower frailty. The 1-year mortality rate after the initial PHF diagnosis was 11.0% for the nonoperative group, 4.0% for ORIF, 5.2% for TSA, and 6.0% for hemiarthroplasty. Compared to nonoperative treatment, ORIF (aOR 0.55; 95% CI [0.47, 0.64]; P<.001) and TSA (aOR 0.59; 95% CI [0.50, 0.68]; P<.001) were associated with decreased odds of 1-year mortality. In the subgroup analysis, ORIF and TSA were associated with a lower 1-year mortality risk for 2-part and 3-/4-part fractures. CONCLUSIONS Compared to nonoperative treatment, surgery (particularly TSA and ORIF) was associated with a decreased odds of 1-year mortality. This relationship remained significant for 2-part and 3-/4-part fractures after stratifying by fracture severity.
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Affiliation(s)
- Akiro H Duey
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brocha Z Stern
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole Zubizarreta
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leesa M Galatz
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Obana KK, Singh P, Namiri NK, Levine WN, Parsons BO, Trofa DP, Parisien RL. The Finger, Wrist, and Shoulder are the Most Commonly Injured Areas in Youth Volleyball Players but the Incidence of Injuries Decreased Overall Between 2012 and 2022. Arthrosc Sports Med Rehabil 2024; 6:100862. [PMID: 38304467 PMCID: PMC10830529 DOI: 10.1016/j.asmr.2023.100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024] Open
Abstract
Purpose To analyze epidemiology, mechanisms, and diagnoses of upper extremity volleyball injuries in youth who present to United States emergency departments. Methods Data from the National Electronic Injury Surveillance System were analyzed for upper extremity volleyball injuries in patients ≤18 years old from January 1, 2012, to December 31, 2022. Data were collected for body part, diagnosis, mechanism of injury, and disposition. Weighted national estimates were calculated using the hospitals' corresponding statistical sample weights. Linear regressions were used to analyze annual trends. χ2 tests were used to analyze categorical variables. Results A weighted national estimate of 131,624 upper extremity volleyball-related injuries occurred in the study period. Average age was 13.9 ± 2.3 years. Female patients constituted 77.6% of patients; 99.3% of patients did not require admission. The most common body parts injured were fingers (43.0%), wrists (22.8%), and shoulders (12.2%). The most common identifiable mechanisms of injury were impacts with the floor (19.4%), impacts with the ball (14.7%), and spikes/serves (5.7%). Most common diagnoses were strains/sprains (42.6%) and fractures (19.5%). Most common locations of fracture were fingers (57.4% of all fractures), wrists (16.6%), and lower arms (12.4%). There was a decrease of 544 overall injuries per year (P = .03, 95% confidence interval [CI] -1031 to -58). Female players experienced more contusions/abrasions (16.0% vs 9.9%, P < .001) and strains/sprains (46.1% vs 30.4%, P < .001) compared with male players. Female patients had decreases of 513 overall injuries (P = .01, 95% CI -881 to -144), 349 strains/sprains (P = .002, 95% CI -530 to -168), 102 contusions/abrasions (P = .008, 95% CI 170 to -34), and 92 fractures per year (P = .03, 95% CI -175 to -10). Conclusions Youth volleyball players are at risk of upper extremity injury, particularly involving the fingers, wrist, and shoulder. Despite increasing national participation in youth volleyball, there is a decreasing incidence of upper extremity injuries. Level of Evidence Level IV, prognostic case series.
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Affiliation(s)
- Kyle K. Obana
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Priya Singh
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Nikan K. Namiri
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - William N. Levine
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Bradford O. Parsons
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - David P. Trofa
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Robert L. Parisien
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York, U.S.A
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Patel AV, White CA, Cirino CM, Duey AH, Ranson WA, Gross BD, Mease S, Galatz LM, Parsons BO, Flatow EL, Cagle PJ. Mid-term outcomes following reverse total shoulder arthroplasty. Eur J Orthop Surg Traumatol 2024; 34:799-807. [PMID: 37707634 DOI: 10.1007/s00590-023-03708-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE The utilization of reverse total shoulder arthroplasty now exceeds the incidence of anatomic shoulder arthroplasty. Previous mid-to-long-term studies on rTSA have reported a decrease in shoulder function as follow-up increased. The purpose of this study was to provide data on mid-term outcomes and implant survival in a series focusing on reverse total shoulder arthroplasty. MATERIALS AND METHODS Demographic information such as age at surgery, revision surgery status, BMI, and smoking status were recorded. The clinical endpoints measured in this study were range of motion scores (forward elevation, external rotation, internal rotation) and patient reported outcomes (VAS, ASES, SST). Radiographic variables captured included preoperative glenoid morphology, humeral lucency, and glenoid loosening. RESULTS Fifty-six shoulders were included in this study. The overall mean age at surgery was 72.5 ± 7.2 years with an average follow-up time of 6.8 ± 3.5 years. The mean BMI was 28.1 ± 5.5. All measurements of range of motion saw significant and sustained improvements. Overall, forward elevation improved from 82° preoperatively to 133° postoperatively (p < 0.01). External rotation improved from 23° preoperatively to 36° (p < 0.01), while internal rotation improved from L3 to L1 (p = 0.05). ASES scores improved from 31 preoperatively to 70 postoperatively (p < 0.01). SST scores improved from 2 preoperatively to 7 (p < 0.01). VAS pain index scores improved from 6 to 2 following surgery (p < 0.01). Postoperative scapular notching was seen in 18 patients at final follow-up. Glenoid loosening was seen in 3 shoulders. Humeral loosening was seen in 18 shoulders. Tuberosity resorption was seen in 8 shoulders. The 5 year survival estimate was 98%, and the 10 year survival estimate was 83%. CONCLUSION In this series, we found that rTSA provides mid-term improvements in range of motion in patients while reducing pain levels. When considered together, this demonstrates that most patients undergoing rTSA can have excellent use of their shoulder from age at surgery to end-of-life.
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Affiliation(s)
- Akshar V Patel
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029, USA
| | - Christopher A White
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029, USA
| | - Carl M Cirino
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029, USA
| | - Akiro H Duey
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029, USA
| | - William A Ranson
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029, USA
| | - Benjamin D Gross
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029, USA.
| | - Samuel Mease
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029, USA
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029, USA
| | - Bradford O Parsons
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029, USA
| | - Evan L Flatow
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029, USA
| | - Paul J Cagle
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York City, NY, 10029, USA
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Yendluri A, Chiang JJ, Linden GS, Megafu MN, Galatz LM, Parsons BO, Parisien RL. The fragility of statistical findings in the reverse total shoulder arthroplasty literature: a systematic review of randomized controlled trials. J Shoulder Elbow Surg 2024:S1058-2746(24)00056-9. [PMID: 38281679 DOI: 10.1016/j.jse.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/14/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) has seen increasing utilization as an effective intervention for a wide variety of shoulder pathologies. The scope and indications for growth are often driven by findings from randomized controlled trials (RCTs) guiding surgical decision-making for RTSA. In this study, we utilized the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to assess the robustness of outcomes reported in RCTs in the RTSA literature. METHODS PubMed, Embase, and MEDLINE were queried for RCTs (Jan. 1, 2010-Mar. 31, 2023) in the RTSA literature reporting dichotomous outcomes. The FI and rFI were defined as the number of outcome reversals required to alter statistical significance for significant and nonsignificant outcomes, respectively. The FQ was determined by dividing the FI by the sample size of each study. Subgroup analysis was performed based on outcome category. RESULTS One hundred seventy-six RCTs were screened with 18 studies included. The median FI across 59 total outcomes was 4 (interquartile range [IQR]: 3-5) with an associated FQ of 0.051 (IQR: 0.029-0.065). Thirteen outcomes were statistically significant with a median FI of 3 (IQR: 1-4) and FQ of 0.033 (IQR: 0.012-0.066). Forty-six outcomes were nonsignificant with a median rFI of 4 (IQR: 3-5) and FQ of 0.055 (IQR: 0.032-0.065). The most fragile outcome category was revision/reoperations with a median FI of 2.50 (IQR: 1.00-3.25), followed by clinical score/outcome (median FI: 3.00), complications (median FI: 4.00), "other" (median FI: 4.00), and radiographic findings (median FI: 5.00). Notably, the number of patients lost to follow-up was greater than or equal to the FI for 59% of outcomes. CONCLUSION The statistical findings in RTSA RCTs are fragile and should be interpreted with caution. Reversal of only a few outcomes, or maintaining postoperative follow-up, may be sufficient to alter significance of study findings. We recommend standardized reporting of P values with FI and FQ metrics to allow clinicians to effectively assess the robustness of study findings.
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Affiliation(s)
- Avanish Yendluri
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | | | - Michael N Megafu
- A.T. Still University Kirksville College of Osteopathic Medicine, Kirksville, MO, USA
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert L Parisien
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Li T, Duey AH, Patel AV, White CA, Levy KH, Ranson WA, Cirino CM, Shukla D, Parsons BO, Flatow EL, Cagle PJ. Cemented vs. press-fit humeral stems: a matched cohort analysis at a mean follow-up of 10 years. J Shoulder Elbow Surg 2024:S1058-2746(24)00030-2. [PMID: 38242528 DOI: 10.1016/j.jse.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Although cementation of humeral stems has long been considered the gold standard for anatomic shoulder arthroplasty (aTSA), cementless, or press-fit, fixation offers a relatively cheaper and less demanding alternative, particularly in the setting of a revision procedure. However, this approach has been accompanied by concerns of implant loosening and high rates of radiolucency. In the present study, we performed a propensity-matched comparison of clinical and patient-reported outcomes between cemented and cementless fixation techniques for aTSA. We hypothesized that cemented fixation of the humeral component would have significantly better implant survival while providing comparable functional outcomes at final follow-up. METHODS This study was a retrospective comparison of 50 shoulders undergoing aTSA: 25 using cemented humeral fixation vs. 25 using press-fit humeral fixation. Patients in the 2 groups were propensity matched according to age, sex, and preoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score. Primary outcome measures included range of motion (ROM) (forward elevation, external rotation, internal rotation), patient-reported outcomes (ASES, Simple Shoulder Test [SST], visual analog scale [VAS]), and implant survival. RESULTS At baseline, the 2 fixation groups were similar in regard to age, sex, body mass index, preoperative ASES score, and surgical indication. Mean follow-up was 11.7 ± 4.95 years in the cemented cohort and 9.13 ± 3.77 years in the press-fit cohort (P = .045). Both groups demonstrated significant improvements postoperatively in all included ROM and patient-reported outcomes. However, press-fit patients reported significantly better VAS, ASES, and SST scores. Mean VAS pain score was 1.1 ± 1.8 in press-fit patients and 3.2 ± 3.0 in cemented patients (P = .005). The mean ASES score was 87.7 ± 12.4 in press-fit patients and 69.5 ± 22.7 in cemented patients (P = .002). Lastly, the mean SST score was 9.8 ± 3.1 in press-fit patients and 7.7 ± 3.7 in cemented patients (P = .040). Both fixation techniques provided lasting implant survivorship with only a single revision operation in each of the cohorts. CONCLUSION Herein, we provide a propensity-matched, long-term comparison of patients receiving anatomic shoulder arthroplasty stratified according to humeral stem fixation technique. The results of this analysis illustrate that both types of humeral fixation techniques yield durable and significant improvements in shoulder function with similar rates of survival at 10 years of follow-up.
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Affiliation(s)
- Troy Li
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akiro H Duey
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V Patel
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher A White
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth H Levy
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William A Ranson
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carl M Cirino
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dave Shukla
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan L Flatow
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Levy KH, White CA, Pujari A, Patel AV, Kator JL, Parsons BO, Galatz LM, Cagle PJ. Subacromial Balloon Spacer Implantation Is a Promising Alternative for Patients With Massive Irreparable Rotator Cuff Tears: A Systematic Review. Arthroscopy 2024; 40:162-173.e2. [PMID: 37355186 DOI: 10.1016/j.arthro.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/20/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To provide an overview of the existing literature on subacromial balloon spacers for the treatment of massive irreparable rotator cuff tears, in an effort to inform surgeons of the procedure's clinical effectiveness. METHODS The PubMed, Scopus, and Ovid EMBASE databases were queried to identify studies evaluating the clinical, radiographic, and patient-reported outcomes of patients indicated for subacromial balloon spacer implantation. The following datapoints were extracted: study demographics, patient baseline characteristics, and postoperative outcomes of interest. Outcomes were evaluated at baseline and at the longest available follow-up period. RESULTS A total 766 patients were included among 22 included studies, with an average follow-up of 27.54 months. Improvements were seen for all clinical and patient-reported outcomes: forward elevation (ranging from 9.20 to 90.00° improvement), external rotation (ranging from 2.00 to 22.00°), abduction (ranging from 14.00 to 95.00°), Total Constant Score (ranging from 7.70 to 50.00), American Shoulder and Elbow Surgeons score (ranging from 24.60 to 59.84), Oxford Shoulder Score (ranging from 7.20 to 22.20), and pain score (ranging from 3.57 to 6.50). Minimal differences were seen in acromiohumeral interval (ranging from -2.00 to 1.27). Reoperation and complication rates ranged from 0% to 33% and 0% to 19.64%, respectively. CONCLUSIONS The short-term results of subacromial balloon spacers for management of massive rotator cuff tears demonstrate clinically relevant improvements in shoulder range of motion and substantial improvements in patient-reported outcome measures. Of note, minimal change in acromiohumeral interval was seen on postoperative radiography, and wide variations in complication and reoperation rates were reported across studies. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Kenneth H Levy
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Christopher A White
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Amit Pujari
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Akshar V Patel
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Jamie L Kator
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Bradford O Parsons
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Paul J Cagle
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A..
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Duey AH, Dieterich JD, Patel AV, White CA, Cirino CM, Li T, Galatz LM, Parsons BO, Flatow EL, Cagle PJ. Superior migration of the humeral head does not significantly affect outcomes at an average of 11 years after total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:2493-2500. [PMID: 37276920 DOI: 10.1016/j.jse.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Superior migration of the humeral head has been linked with rotator cuff dysfunction and glenoid loosening after total shoulder arthroplasty (TSA). We aimed to determine if superior migration was associated with poor shoulder function following anatomic TSA at long-term follow-up. METHODS In this retrospective cohort study, we reviewed patients undergoing TSA by a single surgeon at an urban, academic institution. To study the effect of superior migration on TSA outcomes, we stratified the cohort by ≥ and <7 mm of acromiohumeral interval (AHI) and compared range of motion and patient reported outcomes (PROs). Clinical variables included preoperative and postoperative forward elevation (FE), internal rotation, external rotation, visual analog scale, American Shoulder and Elbow Surgeons shoulder score, and Simple Shoulder Text score. Radiographic variables included immediate postoperative and long-term follow-up AHI, lateral humeral offset, and glenoid loosening scores. RESULTS After applying exclusion criteria, 121 TSAs were included. The mean age was 63.9 ± 9.5 years, and 66 surgeries (55%) were in male patients. The mean follow-up for our cohort was 11.2 years (range, 5-26 years). Nine shoulders underwent revision surgery. All range of motion and PROs improved significantly from preoperative to the most recent postoperative follow-up. The mean AHI immediately following surgery was 10.9 ± 4.1 mm, while the mean AHI at most recent follow-up was 8.4 ± 3.5 mm. Glenoid loosening was observed in 29 (23.8%) shoulders at the most recent follow-up appointment. Although AHI correlated weakly with FE (r = 0.252; P = .006), we did not observe a clear threshold of migration which led to degraded function. Importantly, glenoid loosening was not related to AHI at long-term follow-up (P = .631). None of FE, internal rotation, external rotation, visual analog scale, American Shoulder and Elbow Surgeons shoulder score, Simple Shoulder Text, or revisions were significantly different between patients with ≥ and <7 mm of AHI. CONCLUSION Our results suggest that anatomic TSA provides durable improvements to pain, function, and PROs despite changes to the AHI.
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Affiliation(s)
- Akiro H Duey
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James D Dieterich
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V Patel
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher A White
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carl M Cirino
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Troy Li
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan L Flatow
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Gross BD, White CA, Wang KC, Patel AV, Parsons BO, Cagle PJ. The 50 most-cited articles in reverse shoulder arthroplasty. Shoulder Elbow 2023; 15:82-93. [PMID: 37974642 PMCID: PMC10649503 DOI: 10.1177/17585732231155123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/08/2023] [Accepted: 01/14/2023] [Indexed: 11/19/2023]
Abstract
Background Citation analyses have been used to understand the impact that a group of publications has on its field. As the techniques and indications of reverse total shoulder arthroplasty (RTSA) continue to expand, it is important to identify articles that can orient readers to the history, evolution, and current status of the body of RTSA literature. The purpose of this study was to identify and analyze the 50 most-cited articles related to RTSA. Methods Various Boolean queries were searched on the Clarivate Analytics Web of Science. Information collected included author name, publication year, country of origin, journal name, article type, total number of citations, and level of evidence. Results Top 50 most-cited articles amassed a total of 10,521 citations. The most-cited article was cited a total of 766 times. The most common study designs were case series (28) and cohort studies (9). Authors from the United States (24) contributed the most to included papers, followed by France (19) and Switzerland (8). Discussion The most-cited articles on RTSA are expert opinions, case studies, and cohort studies published by American authors. As RTSA continues to grow over the next decade, studies with higher levels-of-evidence may overtake articles included in this analysis.
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Affiliation(s)
- Benjamin D Gross
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher A White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin C Wang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V Patel
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Gross BD, Patel AV, Duey AH, Cirino CM, Bernstein JD, White CA, Parsons BO, Flatow EL, Cagle PJ. Improved functional, radiographic and patient-reported outcomes at midterm follow-up for shoulder arthroplasty patients 75 years and older. J Orthop 2023; 45:19-25. [PMID: 37822645 PMCID: PMC10562614 DOI: 10.1016/j.jor.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/29/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
Background Current discussion centers around the appropriateness of shoulder arthroplasty in elderly patients, and whether anatomic and reverse total shoulder arthroplasty yield acceptable results in this population. The purpose of this study was to examine midterm outcomes in patients 75 years and older who underwent either procedure. Methods A retrospective review was performed on patients who underwent anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA) between 2000 and 2018. Inclusion criteria was patient age ≥75 years at time of surgery and ≥1 years postoperative follow-up. Primary outcomes were differences in Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Scale (VAS) pain score, and range of motion. A secondary outcome was revision surgery. Results 22 patients who underwent aTSA and 17 patients who underwent rTSA were included. Mean age at surgery was 79 and 80 in the aTSA and rTSA groups, respectively. Mean postoperative follow-up was 6.6 years across both cohorts. Anatomic TSA patients experienced improvements in VAS (7 preop vs. 1 postop; p < 0.001), ASES (16 vs. 75; p < 0.001), and SST (2 vs. 8; p < 0.001) scores. Reverse TSA patients also experienced improvements in VAS (7 vs. 1; p < 0.001), ASES (29 vs. 74; p < 0.001), and SST (1 vs. 7; p < 0.001) scores. Anatomic TSA patients experienced improved external rotation (17° vs. 53°; p < 0.001), forward elevation (108° vs. 155°; p < 0.001), and internal rotation (L5 vs. T10; p < 0.001). Reverse TSA patients experienced improved forward elevation (52° vs. 126°; p < 0.001). 21 aTSA patients (100%) and 16 rTSA patients (94%) experienced survival free from revision. 100% of aTSA and rTSA patients experienced survival free from loosening. Conclusion Both aTSA and rTSA can be performed in the elderly population with acceptable midterm outcomes, suggesting that implant survival and patient satisfaction have the potential to endure through the end of life. Level of evidence IV.
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Affiliation(s)
- Benjamin D. Gross
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Akshar V. Patel
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Akiro H. Duey
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Carl M. Cirino
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Jordan D. Bernstein
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Christopher A. White
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Bradford O. Parsons
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Evan L. Flatow
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Paul J. Cagle
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
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Li T, Duey AH, White CA, Pujari A, Patel AV, Zaidat B, Williams CS, Williams A, Cirino CM, Shukla D, Parsons BO, Flatow EL, Cagle PJ. Evaluating the effects of age on the long-term functional outcomes following anatomic total shoulder arthroplasty. Clin Shoulder Elb 2023; 26:231-237. [PMID: 37607857 PMCID: PMC10497918 DOI: 10.5397/cise.2023.00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND In the past decade, the number of anatomic total shoulder arthroplasty (aTSA) procedures has steadily increased. Patients over 65 years of age comprise the vast majority of recipients, and outcomes have been well documented; however, patients are opting for definitive surgical treatment at younger ages.We aim to report on the effects of age on the long-term clinical outcomes following aTSA. METHODS Among the patients who underwent TSA, 119 shoulders were retrospectively analyzed. Preoperative and postoperative clinical outcome data were collected. Linear regression analysis (univariate and multivariate) was conducted to evaluate the associations of clinical outcomes with age. Kaplan-Meier curves and Cox regression analyses were performed to evaluate implant survival. RESULTS At final follow-up, patients of all ages undergoing aTSA experienced significant and sustained improvements in all primary outcome measures compared with preoperative values. Based on multivariate analysis, age at the time of surgery was a significant predictor of postoperative outcomes. Excellent implant survival was observed over the course of this study, and Cox regression survival analysis indicated age and sex to not be associated with an increased risk of implant failure. CONCLUSIONS When controlling for sex and follow-up duration, older age was associated with significantly better patient-reported outcome measures. Despite this difference, we noted no significant effects on range of motion or implant survival. Level of evidence: IV.
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Affiliation(s)
- Troy Li
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akiro H. Duey
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher A. White
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amit Pujari
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V. Patel
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bashar Zaidat
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christine S. Williams
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexis Williams
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carl M. Cirino
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dave Shukla
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O. Parsons
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan L. Flatow
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J. Cagle
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Li T, Levy KH, Duey AH, Patel AV, White CA, Cirino CM, Williams A, Whitelaw K, Shukla D, Parsons BO, Flatow EL, Cagle PJ. Does humeral fixation technique affect long-term outcomes of total shoulder arthroplasty? Clin Shoulder Elb 2023; 26:245-251. [PMID: 37607863 PMCID: PMC10497929 DOI: 10.5397/cise.2023.00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND For anatomic total arthroscopic repair, cementless humeral fixation has recently gained popularity. However, few studies have compared clinical, radiographic, and patient-reported outcomes between cemented and press-fit humeral fixation, and none have performed follow-up for longer than 5 years. In this study, we compared long-term postoperative outcomes in patients receiving a cemented versus press-fit humeral stem anatomic arthroscopic repair. METHODS This study retrospectively analyzed 169 shoulders that required primary anatomic total shoulder arthroplasty (aTSA). Shoulders were stratified by humeral stem fixation technique: cementation or press-fit. Data were collected pre- and postoperatively. Primary outcome measures included range of motion, patient reported outcomes, and radiographic measures. RESULTS One hundred thirty-eight cemented humeral stems and 31 press-fit stems were included. Significant improvements in range of motion were seen in all aTSA patients with no significant differences between final cemented and press-fit stems (forward elevation: P=0.12, external rotation: P=0.60, and internal rotation: P=0.77). Patient reported outcome metrics also exhibited sustained improvement through final follow-up. However, at final follow-up, the press-fit stem cohort had significantly better overall scores when compared to the cemented cohort (visual analog score: P=0.04, American Shoulder and Elbow Surgeon Score: P<0.01, Simple Shoulder Test score: P=0.03). Humeral radiolucency was noted in two cemented implants and one press-fit implant. No significant differences in implant survival were observed between the two cohorts (P=0.75). CONCLUSIONS In this series, we found that irrespective of humeral fixation technique, aTSA significantly improves shoulder function. However, within this cohort, press-fit stems provided significantly better outcomes than cemented stems in terms of patient reported outcome scores. Level of evidence: III.
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Affiliation(s)
- Troy Li
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth H. Levy
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akiro H. Duey
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V. Patel
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher A. White
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carl M. Cirino
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexis Williams
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathryn Whitelaw
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dave Shukla
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O. Parsons
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan L. Flatow
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J. Cagle
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Brochin RL, Selverian S, Zastrow RK, Patel AV, Parsons BO, Cagle PJ. The Impact of COVID-19 Redeployment on an Orthopedic Surgery Department at a Tertiary Care Medical Center in New York City. Bull Hosp Jt Dis (2013) 2023; 81:131-135. [PMID: 37200331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND The SARS-CoV-2 (COVID-19) pandemic resulted in new, non-orthopedic roles for many members of our New York City based orthopedic department, including redeployment to medicine wards, emergency departments, and intensive care units. The purpose of this study was to determine if certain areas of redeployment predisposed individuals to higher likelihood of positive diagnostic or serologic testing for COVID-19. METHODS In this study, attendings, residents, and phy-sician assistants within our orthopedic department were surveyed to determine their roles during the COVID-19 pandemic and whether they were tested via diagnostic or serologic methods for detecting COVID-19. Additionally, symptoms and missed days of work were reported. RESULTS No significant association between redeployment site and rate of positive COVID-19 diagnostic (p = 0.91) or serologic (p = 0.38) testing was detected. Sixty individuals responded to the survey, with 88.3% of respondents rede-ployed during the pandemic. Nearly half (n = 28) of those redeployed experienced at least one COVID-19 related symptom. Two respondents had a positive diagnostic test, and 10 had a positive serologic test. CONCLUSIONS Area of redeployment during the COVID-19 pandemic is not associated with an increased risk of subse-quently having a positive diagnostic or serologic COVID-19 test.
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14
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Megafu MN, Mian HS, Hassan MM, Parsons BO, Li X, Parisien RL. The Fragility of Statistical Findings in Distal Biceps Tendon Repairs: a Systematic Review of Randomized Controlled Trials. J Shoulder Elbow Surg 2023:S1058-2746(23)00324-5. [PMID: 37075937 DOI: 10.1016/j.jse.2023.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND The purpose of this present study was to perform a fragility analysis to assess the robustness of randomized controlled trials (RCTs) evaluating the distal biceps tendon repairs. We hypothesize that the dichotomous outcomes will be statistically fragile and higher fragility will exist among statistically significant outcomes comparable to other orthopedic specialties. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), randomized controlled trials from 4 orthopedic journals indexed on PubMed from 2000 to 2022 reporting dichotomous measures relating to distal biceps tendon repairs were included. The fragility index (FI) of each outcome was calculated through the reversal of a single outcome event until significance was reversed. The fragility quotient (FQ) was calculated by dividing each fragility index by study sample size. The interquartile range (IQR) was also calculated for the FI and FQ. RESULTS Of the 1038 articles screened, seven RCTs containing 24 dichotomous outcomes were included for analysis. The fragility index and fragility quotient of all outcomes was 6.5 (IQR 4-9) and 0.077 (IQR 0.031-0.123), respectively. However, statistically significant outcomes had a fragility index and fragility quotient of 2 (IQR 2-7) and 0.036 (IQR 0.025-0.091), respectively. The average number of patients lost to follow-up was 2.7 patients with 28.6% of the included studies reporting loss to follow-up (LTF) greater than or equal to 6.5. CONCLUSIONS The literature surrounding distal biceps tendon repair may not be as stable as previously thought and presents a similar fragility index to other orthopedic subspecialties. We therefore recommend triple reporting the P value, fragility index and fragility quotient to aid in the interpretation of clinical findings reported in biceps tendon repair literature.
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Affiliation(s)
- Michael N Megafu
- A.T. Still University, Kirksville College of Osteopathic Medicine, Kirksville, MO, USA.
| | - Hassan S Mian
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN, USA
| | - Mahad M Hassan
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Bradford O Parsons
- Department of Orthopedic Surgery, Mount Sinai Sports Medicine, New York, NY, USA
| | - Xinning Li
- Department of Orthopedic Surgery, Boston University, Boston, MA, USA
| | - Robert L Parisien
- Department of Orthopedic Surgery, Mount Sinai Sports Medicine, New York, NY, USA
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15
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Ardebol J, Hwang S, Horinek JL, Parsons BO, Denard PJ. Arthroscopically Assisted Tensionable Cerclage Reconstruction of an Acromioclavicular Separation With Combined Fixation of the Coracoclavicular and Acromioclavicular Ligaments. Arthrosc Tech 2023; 12:e321-e327. [PMID: 37013023 PMCID: PMC10066044 DOI: 10.1016/j.eats.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/24/2022] [Accepted: 11/03/2022] [Indexed: 04/05/2023] Open
Abstract
A variety of surgical techniques are currently available to manage high-grade acromioclavicular (AC) separations, including hook plates/wires, nonanatomic ligament reconstruction, and anatomic cerclage with or without biological augmentation. Traditional reconstructions focused on the coracoclavicular ligaments alone and often were associated with high rates of recurrent deformity. Biomechanical and clinical data have suggested that additional fixation of the AC ligaments is beneficial. This Technical Note describes an arthroscopically assisted approach for combined reconstruction of the coracoclavicular and AC ligaments with a tensionable cerclage.
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Affiliation(s)
| | | | | | | | - Patrick J. Denard
- Oregon Shoulder Institute, Medford, Oregon
- Address correspondence to Patrick J. Denard, M.D., 2780 E. Barnett Rd., Suite 200, Medford, OR 97504
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White CA, Patel AV, Wang KC, Cirino CM, Parsons BO, Flatow EL, Cagle PJ. The impact of tobacco use on clinical outcomes and long-term survivorship after anatomic total shoulder arthroplasty. J Orthop 2023; 36:99-105. [PMID: 36659901 PMCID: PMC9842961 DOI: 10.1016/j.jor.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/13/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Introduction Postoperative outcomes following total shoulder arthroplasty can be affected by preoperative health factors such as tobacco usage. Methods The charts of patients who underwent anatomic total shoulder arthroplasty were retrospectively analyzed and stratified based on smoking status. The primary data included range of motion and patient reported outcomes. Additionally, demographic, radiographic, and survivorship analyses were conducted. All data were analyzed using statistical inference. Results There were 78, 49, and 16 non-smoker, former smoker, and current smoker shoulders respectively with no significant differences in sex, American Society of Anesthesiologists status, body mass index, or mean follow-up time (average: 10.7 yrs). Smokers (51.5 ± 10.4 years) were younger than both non-smokers (64.9 ± 8.1 years; p < 0.01) and former smokers (65.1 ± 9.1years; p < 0.01) at the time of surgery. For non-smokers and former smokers, all range of motion and patient reported outcome scores significantly improved. Smokers reported significant improvements in all patient reported outcomes and external and internal rotation. Visual Analog Scale, American Shoulder and Elbow, and Simple Shoulder Test scores were lower for smokers comparatively, but these differences did not reach significance. Forward elevation was higher postoperatively for non-smokers (149.7o ± 17.2o) and former smokers (147.1o ± 26.0o) compared to current smokers (130.9o ± 41.2o; p = 0.017). No differences between the cohorts were found in the radiographic analysis. Revision rates were lower in the non-smoking cohort (7.7%) compared to both former (20.4%; p = 0.036) and current smokers (37.5%; p < 0.01). Survival curves showed that non-smoker implants lasted longer than those of current smokers. Conclusion After a decade, patients generally had improved shoulder range of motion, functionality, and pain regardless of smoking status. However, current smokers required shoulder replacements sooner and revision surgery more frequently.
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Affiliation(s)
- Christopher A. White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Akshar V. Patel
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Kevin C. Wang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Carl M. Cirino
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Bradford O. Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Evan L. Flatow
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Paul J. Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, USA
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Duey AH, Li T, White CA, Patel AV, Cirino CM, Parsons BO, Flatow EL, Cagle PJ. A comparison of pegged and keeled glenoid clinical outcomes at long-term follow-up after total shoulder arthroplasty. J Orthop 2023; 36:120-124. [PMID: 36710938 PMCID: PMC9876778 DOI: 10.1016/j.jor.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 01/21/2023] Open
Abstract
Background The two main glenoid types used in total shoulder arthroplasty (TSA) are the pegged and keeled glenoid designs. We aimed to determine if a pegged glenoid is superior to a keeled glenoid at long-term follow-up as measured by range of motion (ROM), patient reported outcomes (PROs), and radiographic glenoid loosening. Methods We retrospectively reviewed all patients undergoing TSA by a single surgeon at an urban, academic hospital. The cohort was stratified into two groups based on glenoid type - one group consisting of keeled implants and a second group consisting of pegged implants. For each patient, forward elevation (FE), internal rotation (IR), external rotation (ER), visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) shoulder score, and simple shoulder test (SST) scores were collected preoperatively and at the most recent follow-up visit. Radiographic variables included acromiohumeral interval (AHI) and glenoid loosening. Results After applying exclusion criteria, 144 TSAs were included in our study. Of these, 42 (29.2%) had keeled glenoids and 102 (70.8%) had pegged glenoids. Patients with a pegged glenoid implant were older (67.4 vs. 60.7 years; p < 0.001) and had a shorter follow-up time (9.3 vs. 14.4 years; p < 0.001) than patients with a keeled glenoid implant. At the most recent follow-up visit, there were no significant differences among postoperative FE, ER, AHI, or PROs. However, pegged glenoid implants provided significantly more internal rotation (T11 vs. L1; p = 0.010) and were less likely to show evidence of radiographic glenoid loosening (16.7% vs. 42.9%; p=<0.001). Revision rates were not significantly different between the pegged and keeled groups (6.9% vs. 14.3%; p = 0.158). Conclusion Although a pegged design correlated with superior internal rotation and less radiographic glenoid loosening, both pegged and keeled glenoid designs offered favorable long-term clinical outcomes following TSA over the long-term.
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Affiliation(s)
- Akiro H. Duey
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029, USA
| | - Troy Li
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029, USA
| | - Christopher A. White
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029, USA
| | - Akshar V. Patel
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029, USA
| | - Carl M. Cirino
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029, USA
| | - Bradford O. Parsons
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029, USA
| | - Evan L. Flatow
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029, USA
| | - Paul J. Cagle
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, NY, 10029, USA
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White CA, Patel AV, Cirino CM, Wang KC, Gross BD, Parsons BO, Flatow EL, Cagle PJ. Does body mass index influence long-term outcomes after anatomic total shoulder arthroplasty? J Shoulder Elbow Surg 2022; 32:991-1000. [PMID: 36464204 DOI: 10.1016/j.jse.2022.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND As of 2018, upwards of 42% of the US adult population was considered obese based on body mass index (BMI) scales. With the annual number of total joint replacements increasing, this study aimed to evaluate the impact BMI has on anatomic total shoulder arthroplasty (aTSA) outcomes. METHODS This was a retrospective analysis of 128 shoulders requiring primary aTSA. Patients were stratified into 3 cohorts based on their BMI at surgery: underweight/normal weight (U/NW; BMI ≤25.0), overweight (25.0 < BMI ≤ 30.0), and obese (BMI >30.0). BMI was separately analyzed as a continuous variable. Clinical endpoints were range of motion scores, including forward elevation, external rotation, and internal rotation, and patient-reported outcomes, including visual analog scale (VAS) scores, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores, and the Simple Shoulder Test (SST). Survivorship curves were calculated using Kaplan-Meier analysis. RESULTS Forty-four, 50, and 34 patient shoulders were in the U/NW, overweight, and obese cohorts, respectively. The mean follow-up time was 11.4 years. The U/NW cohort had more females (73%) compared with the overweight (34%; P = .0030) and obese (35%; P = .0015) groups; no differences were seen in revision rates. BMI was negatively correlated with age at surgery (r = -0.19, P = .014); it was not correlated with any of the 6 postoperative clinical endpoints. All 3 cohorts saw significant improvements in forward elevation, external rotation, internal rotation and VAS, ASES, and SST scores when compared preoperatively to postoperatively (P < .001). There were no significant differences between the 3 cohorts with respect to postoperative range of motion. Postoperative ASES scores were higher for the overweight cohort (82.6 ± 18.6) compared with both the U/NW (63.0 ± 25.1) and obese cohorts (70.5 ± 26.8) (P < .001). The overweight cohort also had higher SST (P = .0012) postoperative scores compared with the U/NW and obese cohorts; VAS scores were comparable between groups (P = .12). The nonobese (BMI <30) group (n = 94) showed 5-, 10-, and 15-year implant survival of 98.9%, 94.9%, and 83.9%, respectively compared to 97.1%, 93.7%, and 87.0% in the obese (BMI ≥30) group (n = 34). The log rank test revealed no significant difference in survival curves (P = .82). CONCLUSION To our knowledge, this is the longest follow-up study analyzing clinical endpoints stratified by BMI for aTSA. We saw that patients with a higher BMI required shoulder replacement at a significantly younger age. However, we also report that regardless of BMI, all patients saw significant improvements in patient-reported outcomes and range of motion scores postoperatively.
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Affiliation(s)
- Christopher A White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V Patel
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carl M Cirino
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin C Wang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin D Gross
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan L Flatow
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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19
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Wang KC, Kantrowitz DE, Patel AV, Parsons BO, Flatow EL, Cagle PJ. Survivorship of total shoulder arthroplasty vs. hemiarthroplasty for the treatment of avascular necrosis at greater than 10-year follow-up. J Shoulder Elbow Surg 2022; 31:1782-1788. [PMID: 35339708 DOI: 10.1016/j.jse.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Avascular necrosis (AVN) of the humeral head is a debilitating pathology that can be managed with an array of treatments depending on disease staging. Humeral head arthroplasty for AVN has demonstrated good short-term improvements in pain and range of motion, but the published long-term outcomes data are limited. The objective of this study was to report long-term survivorship and outcomes for patients undergoing hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) for the treatment of AVN of the humeral head. METHODS The practice of one fellowship-trained shoulder surgeon was queried for the surgical treatment of AVN of the humeral head via appropriate International Classification of Diseases, Ninth and Tenth Revision, codes. Sixteen shoulders that met inclusion criteria were identified. Demographics included the radiographic stage, age, sex, American Society of Anesthesiologists (ASA) score, and body mass index. The primary endpoint was survivorship of the implant. Secondary endpoints were range of motion in forward elevation, internal and external rotation, visual analog scale for pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, and the Simple Shoulder Test score. RESULTS Of the 16 shoulders included in the study, 10 underwent HA and 6 underwent TSA. The TSA cohort was significantly older (mean 60.5 vs. 44.2, P = .005), with a higher mean ASA score (mean 3.0 vs. 2.13, P = .02) than the HA group. The 10-year survivorship rates were 88.9% for HA and 80% for TSA with no significant difference between groups. Survivorship data were available for a mean 13.0 ± 5.6 years' follow-up in the HA group and 13.8 ± 4.8 years in the TSA group. When compared to one another, the results between HA and TSA only differed in internal rotation, which was statistically significantly improved in the TSA group compared with HA (2.3 ± 2.6 compared with -3.0 ± 5.0, P = .03). CONCLUSION The survivorship of both TSA and HA for the treatment of AVN was at least 80% at 10 years. Secondary endpoints, such as range of motion, pain, and shoulder function, improved significantly postoperatively in each cohort and were similar between the 2 groups, except for internal rotation, which had improved significantly more in the TSA group than in HA. Both TSA and HA are viable options for the treatment of AVN, each with durable long-term survival.
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Affiliation(s)
- Kevin C Wang
- Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York, NY, USA
| | - David E Kantrowitz
- Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York, NY, USA.
| | - Akshar V Patel
- Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York, NY, USA
| | - Evan L Flatow
- Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York, NY, USA
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Wang KC, Butler LR, White CA, Patel AV, Parsons BO, Cagle PJ. Impacto da COVID-19 no momento de reparo do manguito rotador e método de acompanhamento pós-operatório. Rev Bras Ortop 2022. [DOI: 10.1055/s-0042-1749206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Resumo
Objetivo O reparo do manguito rotador (RMR) é um dos procedimentos artroscópicos mais comuns. Nossa pesquisa visa quantificar o impacto da pandemia de COVID-19 sobre o RMR, especificamente em pacientes com lesões agudas e traumáticas.
Métodos Os prontuários institucionais foram consultados para identificação de pacientes submetidos ao RMR artroscópico entre 1° de março e 31 de outubro de 2019 e de 2020. Dados demográficos, pré-operatórios, perioperatórios e pós-operatórios dos pacientes foram coletados de prontuários eletrônicos. Os dados foram analisados por estatística inferencial.
Resultados Totais de 72 e de 60 pacientes foram identificados em 2019 e 2020, respectivamente. Os pacientes de 2019 apresentaram menor intervalo entre a ressonância magnética (RM) e a cirurgia (62,7 ± 70,5 dias versus 115,7 ± 151,0 dias; p = 0,01). Os exames de RM mostraram menor grau médio de retração em 2019 (2,1 ± 1,3 cm versus 2,6 ± 1,2 cm; p = 0,05), mas nenhuma diferença foi observada na extensão anteroposterior da laceração entre os anos (1,6 ± 1,0 cm versus 1,8 ± 1,0 cm; p = 0,17). Em 2019, o número de pacientes atendidos por seus cirurgiões em consultas pós-operatórias por telemedicina foi menor em comparação com 2020 (0,0% versus 10,0%; p = 0,009). Não foram observadas alterações significativas nas taxas de complicação (0,0% versus 0,0%; p > 0,999), de readmissão (0,0% versus 0,0%; p > 0,999) ou de revisão (5,6% versus 0,0%; p = 0,13).
Conclusão Não houve diferenças significativas nos dados demográficos dos pacientes ou nas principais comorbidades entre 2019 e 2020. Nossos dados sugerem que, embora o intervalo entre a RM e a cirurgia tenha sido maior em 2020 e tenha havido necessidade de consultas por telemedicina, o RMR ainda foi realizado em tempo hábil e sem alterações significativas nas complicações precoces.
Nível de Evidência III.
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Affiliation(s)
- Kevin C. Wang
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
| | - Liam R. Butler
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
| | - Christopher A. White
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
| | - Akshar V. Patel
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
| | - Bradford O. Parsons
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
| | - Paul J. Cagle
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
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21
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Brochin RL, Zastrow RK, Patel AV, Parsons BO, Galatz LM, Flatow EL, Cagle PJ. Long-term clinical and radiographic outcomes of total shoulder arthroplasty in patients under age 60 years. J Shoulder Elbow Surg 2022; 31:S63-S70. [PMID: 35341970 DOI: 10.1016/j.jse.2022.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND We aimed to characterize the long-term clinical and radiographic outcomes of total shoulder arthroplasty (TSA) in patients aged < 60 years. We hypothesized meaningful improvements in shoulder functionality and pain with TSA and an acceptably low rate of prosthesis complications and revisions. METHODS This was a retrospective cohort study of 29 patients (34 shoulders) undergoing TSA before age 60 years with a minimum follow-up period of 10 years. Shoulder range of motion, functionality (American Shoulder and Elbow Surgeons and Simple Shoulder Test scores), and pain (visual analog scale score) were evaluated. Radiographs were assessed for lateral humeral offset, the acromiohumeral interval, and glenoid loosening. RESULTS The mean age of the patients was 54.4 ± 5.5 years (range, 35.5-59.8 years), with a mean follow-up period of 16.1 ± 4.5 years (range, 10.0-26.1 years). In patients aged < 60 years, TSA significantly improved forward elevation (from 119° ± 26° to 146° ± 21°, P = .0002), external rotation (from 21° ± 25° to 52° ± 15°, P = .0001), and internal rotation (from L5 to L1, P = .002). Additionally, TSA significantly increased American Shoulder and Elbow Surgeons scores (from 32 ± 20 to 64 ± 27, P = .0008) and Simple Shoulder Test scores (from 3 ± 2 to 7 ± 4, P = .0004) and reduced visual analog scale pain scores (from 7 ± 3 to 3 ± 3, P = .0001). Radiographically, there was no significant difference in mean lateral humeral offset (13 ± 6 mm vs. 10 ± 12 mm, P = .472) or the mean acromiohumeral interval (20 ± 4.2 mm vs. 16 ± 6 mm, P = .061) between immediate postoperative and final follow-up radiographs. Radiographic evidence of glenoid loosening was noted in 2 patients. Complications occurred in 6 patients (17.6%), all of which were cases of aseptic glenoid loosening. Ultimately, 4 patients underwent conversion to a reverse TSA and 2 underwent arthroscopic glenoid removal. The rate of prosthesis survivorship was 97.1% (95% confidence interval [CI], 91.4%-100%) at 10 years, 85.4% (95% CI, 73.7%-97.2%) at 15 years, and 80.1% (95% CI, 65.1%-98.4%) at 20 years. DISCUSSION TSA consistently improved shoulder functionality and reduced pain while limiting the need for further revisions. These findings suggest that TSA is a viable treatment option for glenohumeral arthritis in younger patients.
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Affiliation(s)
- Robert L Brochin
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryley K Zastrow
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V Patel
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan L Flatow
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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22
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Patel AV, Matijakovich DJ, Brochin RL, Zastrow RK, Parsons BO, Flatow EL, Hausman MR, Cagle PJ. Mid-term outcomes after reverse total shoulder arthroplasty with latissimus dorsi transfer. Shoulder Elbow 2022; 14:286-294. [PMID: 35599719 PMCID: PMC9121289 DOI: 10.1177/1758573221996349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
Background Reverse total shoulder arthroplasty is a common treatment for patients with rotator cuff arthropathy who have failed a prior rotator cuff repair. Latissimus dorsi transfer can be performed simultaneously to reverse total shoulder arthroplasty for patients with preoperative external rotation deficiency. Current literature is limited with several studies providing functional and pain improvements at short-term follow-up; however, there is a deficit in data regarding mid-term outcomes. The purpose of this study was to evaluate the clinical and radiographic outcomes following reverse total shoulder arthroplasty with latissimus dorsi transfer with mid-term follow-up. We hypothesized significant improvement in external rotation and shoulder functionality for patients with preoperative external rotation lag. Methods We retrospectively reviewed patients who underwent reverse total shoulder arthroplasty with latissimus dorsi transfer. Preoperative and postoperative changes in range of motion were assessed. American Shoulder and Elbow Surgeon Score and the Simple Shoulder Test were used to evaluate changes in shoulder function while pain scores were assessed using the Visual Analog Scale (VAS). Radiographs were reviewed for rotator cuff arthropathy, fatty infiltration, scapular notching, baseplate loosening, and osteolysis. We reported frequency and mean ± standard deviation for categorical and continuous variables, respectively. Means were compared using the paired Student's t-test and proportions using the Chi-square test. Results Fifteen patients met the inclusion criteria. The mean age of the cohort was 71.7 ± 8.4 years (range 51.2-87.8 years) with a mean follow-up of 6.3 ± 4.1 years (range 1.0-14.5 years). Reverse total shoulder arthroplasty with latissimus dorsi transfer improved external rotation (-7 ± 21.3° to 38 ± 15.8°; p value = 0.001). There was no statistically significant difference regarding forward flexion (116.3 ± 45.4° to 133.7 ± 14.7°; p value = 0.17) and internal rotation (T12 to L2; p value = 0.57). The procedure led to an increase in American Shoulder and Elbow Surgeon Score scores (37 ± 19 to 62 ± 22; p = 0.005) and Simple Shoulder Test scores (2 ± 2 to 6 ± 3; p value = 0.001) with a significant reduction in Visual Analog Scale scores (5 ± 3 to 2 ± 3; p value = 0.022). The procedure corrected external rotation lag in 10 patients. Radiographically, rotator cuff arthropathy was found to be grade 3 in two patients, grade 4 A in four patients, grade 4B in eight patients, and grade 5 in one patient. On postoperative imaging, scapular notching was found in six patients (40%). Twelve patients had cortical humeral erosion at the site of the latissimus dorsi transfer. Only one patient experienced a shoulder-related complication which was aseptic baseplate loosening and required a revision reverse total shoulder arthroplasty with allograft. Conclusions In this study, patients undergoing reverse total shoulder arthroplasty with latissimus dorsi transfer experienced improvements in range of motion, functional scores, and pain at mid-term follow-up. The shoulder-related complication rate was low.Level of evidence: IV; Case series.
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23
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Vervaecke AJ, Carbone AD, Zubizarreta N, Poeran J, Parsons BO, Verborgt O, Galatz LM, Cagle PJ. Reverse shoulder arthroplasty for rotator cuff tears with and without prior failed rotator cuff repair: A large-scale comparative analysis. J Orthop 2022; 31:1-5. [PMID: 35299693 PMCID: PMC8920866 DOI: 10.1016/j.jor.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/06/2022] [Indexed: 10/18/2022] Open
Abstract
Background Large-scale data assessing the effect of a prior failed rotator cuff repair (RCR) on the outcome of reverse shoulder arthroplasty (RSA) is currently lacking. Therefore, this study aimed (1) to assess the course of patients undergoing RCR, specifically focusing on the need for conversion to RSA within two years, and (2) to compare outcomes following RSA performed for rotator cuff tears (RCTs) with and without prior RCR. Methods This retrospective cohort study included data from the CMS Data Set (2016-2018). For the first study objective, we included patients undergoing an RCR; these were followed for 24 months to identify a conversion to RSA. For the second study objective, we included RSAs for RCTs, stratified by those with and without a prior RCR (preceding 24 months). Outcomes (hospitalization cost, institutional post-acute care discharge, 90-day readmission and health resource utilization up to 6 months post-RSA) were compared between propensity score-matched groups. Results Out of 33,244 RCRs, 433 (1.3%) patients underwent RSA conversion within two years. Among 7534 RSA cases for RCTs, 245 (3.3%) had an RCR in the preceding two years. In the propensity score analysis, except for a minimal increase in the number of physical rehabilitation visits (RR 1.10; p = 0.0009), no differences were observed between those with and without prior RCR in terms of other RSA outcomes. These included hospitalization cost, discharge to institutional post-acute care facility, 90-day readmission and 6-month post-op cost. Conclusion Rotator cuff repair in elderly patients, when utilizing currently employed indication criteria, results in low conversion rates to RSA within 2 years postoperatively. Furthermore, large dataset outcomes after RSA for RCT such as cost, post-acute care discharge, physical rehabilitation, and readmission rates appear not to be negatively affected by the presence of a prior RCR. Level of evidence Level 3 evidence; Retrospective cohort study.
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24
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Haidamous G, Lädermann A, Hartzler RU, Parsons BO, Lederman ES, Tokish JM, Denard PJ. Radiographic parameters associated with excellent versus poor range of motion outcomes following reverse shoulder arthroplasty. Shoulder Elbow 2022; 14:39-47. [PMID: 35154401 PMCID: PMC8832695 DOI: 10.1177/1758573220936234] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose was to evaluate the relationship of component size and position to postoperative range of motion following reverse shoulder arthroplasty. The hypothesis was that increased lateralization, larger glenospheres, and a decreased acromiohumeral distance would be associated with excellent postoperative range of motion. METHODS A retrospective multicenter study was performed at a minimum of one year postoperatively on 160 patients who underwent primary reverse shoulder arthroplasty with a 135° humeral component. Outcomes were stratified based on postoperative forward flexion and external rotation into excellent (n = 42), defined as forward flexion >140° and external rotation > 30°, or poor (n = 36), defined as forward flexion <100° and external rotation < 15°. Radiographic measurements and component features were compared between the two groups. RESULTS A larger glenosphere size was associated with an excellent outcome (p = 0.009). A 2-mm posterior offset humeral cup (p = 0.012) and an increased inferior glenosphere overhang (3.1 mm vs 1.4 mm; p = 0.002) were also associated with excellent outcomes. Humeral lateralization and distalization were not associated with an excellent outcome.Conclusion: Larger glenosphere size and inferior positioning as well as posterior humeral offset are associated with improved postoperative range of motion following reverse shoulder arthroplasty. LEVEL OF EVIDENCE Level 3, retrospective comparative study.
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Affiliation(s)
| | - Alexandre Lädermann
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | | | | | - Evan S Lederman
- University of Arizona College of Medicine Phoenix and the Orthopedic Clinic Association, Phoenix, AZ, USA
| | | | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA,Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, OR, USA,Patrick J Denard, Southern Oregon Orthopedics, 2780 E. Barnett Road, Suite 200, Medford, OR 97530, USA.
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25
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Carbone A, Vervaecke AJ, Ye IB, Patel AV, Parsons BO, Galatz LM, Poeran J, Cagle P. Outpatient versus inpatient total shoulder arthroplasty: A cost and outcome comparison in a comorbidity matched analysis. J Orthop 2021; 28:126-133. [PMID: 34937996 DOI: 10.1016/j.jor.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background Previous studies comparing total and reverse shoulder arthroplasty (TSA/RSA) are subject to surgeon selection bias. This study objective is to compare the outcomes and cost of outpatient TSA/RSA to inpatient TSA/RSA. Methods 108,889 elective inpatient and outpatient TSA/RSA from Medicare claims data (2016-2018). 90-day readmission and total 90-day costs were compared following propensity score matching. Results Younger and healthier patients are receiving outpatient TSA/RSA. Outpatient TSA/RSA was associated with fewer 90-day readmissions (OR 0.48 CI 0.38-0.59, p < 0.001) and lower 90-day costs (-20.1% CI -19.1%; -21.1%, p < 0.001). Conclusions Outpatient TSA/RSA surgery offers lower complication rates and total costs. Level of evidence III.
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Affiliation(s)
- Andrew Carbone
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ivan B Ye
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V Patel
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leesa M Galatz
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Healthy Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Cagle
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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26
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Wang KC, Patel AV, White CA, Gross BD, Parsons BO, Cagle PJ. Efeito da COVID-19 na artroplastia de ombro em um centro médico terciário na cidade de Nova York. Rev Bras Ortop 2021; 58:121-126. [PMID: 36969784 PMCID: PMC10038706 DOI: 10.1055/s-0041-1735950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022] Open
Abstract
Resumo
Objetivo A pandemia de COVID-19 causou uma pausa sem precedentes em cirurgias eletivas, inclusive artroplastia de ombro. Procuramos determinar as possíveis diferenças clínicas e/ou demográficas entre os pacientes que realizaram artroplastia de ombro durante a pandemia em comparação com o ano anterior (2019).
Métodos Os registros institucionais foram consultados para obtenção de informações sobre pacientes submetidos a artroplastia de ombro entre 1° de março a 1° de julho de 2019 e 2020. Dados demográficos, amplitude de movimento, duração da cirurgia, tempo de hospitalização, condições à alta e manejo pós-operatório foram analisados.
Resultados O tempo médio de cirurgia foi de 160 ± 50 minutos em 2020 e de 179 ± 54 minutos em 2019 (p = 0,13). O tempo médio de internação foi de 36 ± 13 horas em 2020 e de 51 ± 40 horas em 2019 (p = 0,04). Em 2019, 96% dos pacientes fizeram fisioterapia, enquanto 71% o fizeram em 2020 (p = 0,003). Todos os pacientes de 2019 e 86% dos pacientes de 2020 participaram do acompanhamento pós-operatório presencial (p = 0,006). Os pacientes de 2019 retornaram para a consulta médica em média 14 ± 11 dias após a cirurgia; os pacientes de 2020 retornaram para o acompanhamento em 25 ± 25 dias (p = 0,10). A amplitude de movimento, a idade, a pontuação da American Society of Anesthesiologists (ASA, na sigla em inglês) e as taxas de complicações não diferiram entre as coortes.
Conclusão Os pacientes submetidos a cirurgia na fase inicial da pandemia eram demográfica e clinicamente semelhantes aos pacientes de 2019. No entanto, o tempo de internação diminuiu de forma significativa durante a pandemia de COVID-19. O acompanhamento pós-operatório e a fisioterapia foram adiados em 2020, mas isso não levou a diferenças nas taxas de complicações ou de reinternações em comparação às da coorte de 2019.
Nível de Evidência III.
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Affiliation(s)
- Kevin C. Wang
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Akshar V. Patel
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Christopher A. White
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Benjamin D. Gross
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Bradford O. Parsons
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
| | - Paul J. Cagle
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, New York City, New York, Estados Unidos
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Shah SS, Sahota S, Denard PJ, Provencher MT, Parsons BO, Hartzler RU, Dines JS. Variability in total shoulder arthroplasty planning software compared to a control CT-derived 3D printed scapula. Shoulder Elbow 2021; 13:268-275. [PMID: 34659466 PMCID: PMC8513001 DOI: 10.1177/1758573219888821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Two techniques exist from which all 3D preoperative planning software for total shoulder arthroplasty are based. One technique is based on measurements constructed on the mid-glenoid and scapular landmarks (Landmark). The second is an automated system using a best-fit sphere technique (Automated). The purpose was to compare glenoid measurements from the two techniques against a control computed tomography-derived 3D printed scapula. METHODS Computed tomography scans of osteoarthritic shoulders of 20 patients undergoing primary total shoulder arthroplasty were analyzed with both 3D planning software techniques. Measurements from a 3D printed scapula (Scapula) from the true 3D computed tomography scan served as controls. Glenoid version and inclination measurements from each group were blinded and reviewed. RESULTS In 65% (Automated) and 45% (Landmark) of cases, either inclination or version varied by 5° or more versus 3D printed scapula. Significant variability in version differences compared to the scapula group existed (p = 0.007). Glenoid version from the Scapula = 13.0° ± 10.6°, Automated = 15.0° ± 13.9°, and Landmark = 12.2° ± 7.8°. Inclination from Scapula = 5.4° ± 7.9°, Automated = 6.1° ± 12.6°, and Landmark = 6.2° ± 9.1°. DISCUSSION A high percentage of cases showed discrepancies in glenoid inclination and version values from both techniques. Surgeons should be aware that regardless of software technique, there is variability compared to measurements from a control 3D computed tomography printed scapula.
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Affiliation(s)
| | | | | | | | - Bradford O Parsons
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Carbone A, Poeran J, Zubizarreta N, Chan J, Mazumdar M, Parsons BO, Galatz LM, Cagle PJ. Administration of tranexamic acid during total shoulder arthroplasty is not associated with increased risk of complications in patients with a history of thrombotic events. J Shoulder Elbow Surg 2021; 30:104-112. [PMID: 32807373 DOI: 10.1016/j.jse.2020.04.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Tranexamic acid (TXA) has been shown to reduce blood loss and transfusion risk in various orthopedic surgeries including shoulder arthroplasty. However, concerns still exist regarding its use in patients with a history of thrombotic events. Using national claims data, we aimed to study the safety of TXA administration in shoulder arthroplasty patients with a history of thrombotic events. METHODS We used retrospective national claims data (Premier Healthcare) on 71,174 patients who underwent a total or reverse shoulder arthroplasty between 2010 and 2016. TXA use was evaluated specifically within a subgroup of patients with a history of thrombotic events such as myocardial infarction, deep venous thrombosis, pulmonary embolism, transient ischemic attack, or ischemic stroke. Studied outcomes were blood transfusion need, complications (including acute renal failure, new onset myocardial infarction, deep venous thrombosis, pulmonary embolism, transient ischemic attack, or ischemic stroke), and cost and length of hospitalization. Mixed-effects models measured the association between TXA use and outcomes, separately in patients with and without a history of thrombotic events. Odds ratios (OR) or percent change for continuous outcomes with 95% confidence intervals (CI) were reported. RESULTS Overall, TXA was used in 13.7% (n = 9735) of patients, whereas 10.5% (n = 7475) of patients had a history of a thrombotic event. After adjustment for relevant covariates, TXA use (compared with no TXA use) in patients without a history of thrombotic events was associated with decreased odds of blood transfusions (OR, 0.48; CI, 0.24-0.98; P = .0444), whereas no increased odds for complications were observed (OR, 0.83; CI, 0.40-1.76; P = .6354). Similar results were observed in patients with a history of thrombotic events. Moreover, in this subgroup, TXA use was associated with a slight reduction in hospitalization cost (-8.9% CI: -13.1%; -4.6%; P < .0001; group median $18,830). CONCLUSIONS Among shoulder arthroplasty patients, TXA use was not associated with increased complication odds, independent of a history of thrombotic events. These findings are in support of wider TXA use.
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Affiliation(s)
- Andrew Carbone
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jashvant Poeran
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Healthy Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole Zubizarreta
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Healthcare Delivery Science, Department of Population Healthy Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jimmy Chan
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhu Mazumdar
- Institute for Healthcare Delivery Science, Department of Population Healthy Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leesa M Galatz
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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O'Sullivan J, Lädermann A, Parsons BO, Werner B, Steinbeck J, Tokish JM, Denard PJ. A systematic review of tuberosity healing and outcomes following reverse shoulder arthroplasty for fracture according to humeral inclination of the prosthesis. J Shoulder Elbow Surg 2020; 29:1938-1949. [PMID: 32815808 DOI: 10.1016/j.jse.2020.03.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal humerus fractures are common in the elderly population and are often treated with reverse shoulder arthroplasty (RSA). The purpose of this systematic review was to compare tuberosity healing and functional outcomes in patients undergoing RSA with humeral inclinations of 135°, 145°, and 155°. METHODS A systematic review was performed of RSA for proximal humerus fracture using Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. Radiographic and functional outcome data were extracted to evaluate tuberosity healing according to humeral inclination. Analysis was also performed of healed vs. nonhealed tuberosities. RESULTS A total of 873 patients in 21 studies were included in the analysis. The mean age was 77.5 years (range of 58-97) and the mean follow-up was 26.2 months. Tuberosity healing was 83% in the 135° group compared with 69% in the 145° group and 66% in the 155° group (P = .030). Postoperative abduction was highest in the 155° group (P < .001). No significant difference was found in forward flexion, external rotation, or postoperative Constant score between groups. Patients with tuberosity healing demonstrated 18° higher forward flexion (P = .008) and 16° greater external rotation (P < .001) than those with unhealed tuberosities. CONCLUSION RSA for fracture with 135° humeral inclination is associated with higher tuberosity healing rates compared with 145° or 155°. Postoperative abduction is highest with a 155° implant, but there is no difference in in postoperative forward flexion, external rotation, or Constant score according to humeral inclination. Patients with healed tuberosities have superior postoperative forward flexion and external rotation than those with unhealed tuberosities.
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Affiliation(s)
- Joseph O'Sullivan
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Alexandre Lädermann
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Bradford O Parsons
- Department of Orthopedics, Mount Sinai Medical Center, New York, NY, USA
| | - Brian Werner
- Department of Orthopedics, University of Virginia, Charlottesville, VA, USA
| | | | - John M Tokish
- Department of Orthopedics, Mayo Clinic, Scottsdale, AZ, USA
| | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA; Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
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Abstract
AIMS Heterotopic ossification (HO) is a potentially devastating complication of the surgical treatment of a proximal humeral fracture. The literature on the rate and risk factors for the development of HO under these circumstances is lacking. The aim of this study was to determine the incidence and risk factors for the development of HO in these patients. METHODS A retrospective analysis of 170 patients who underwent operative treatment for a proximal humeral fracture between 2005 and 2016, in a single institution, was undertaken. The mean follow-up was 18.2 months (1.5 to 140). The presence of HO was identified on follow-up radiographs. RESULTS The incidence of HO was 15% (n = 26). Our multivariate model revealed that male sex (odds ratio (OR) 3.57, 95% confidence interval (CI) 1.30 to 9.80 compared to female) and dislocation as the initial injury (OR 5.01, 95% CI 1.31 to 19.22) were significantly associated with the formation of HO (p < 0.05) while no significant associations were seen for the age of the patient, the characteristics of the injury, or the type of operative treatment. CONCLUSION This retrospective radiological study is the first to investigate the association between the method of surgical treatment for a proximal humeral fracture and the formation of HO postoperatively. We found that male sex and dislocation as the initial injury were risk factors for HO formation, whereas the method of surgical treatment, the age of the patient, and the pattern of the fracture were not predictive of HO formation. While additional studies are needed, these findings can help to identify those at an increased risk for HO formation under these circumstances. Cite this article: Bone Joint J 2020;102-B(4):539-544.
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Affiliation(s)
- Carl M Cirino
- Leni and Peter W. May Departmentof Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jimmy J Chan
- Leni and Peter W. May Departmentof Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diana C Patterson
- Leni and Peter W. May Departmentof Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rachel Jia
- Center for Clinical and Outcomes Research, Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jashvant Poeran
- Center for Clinical and Outcomes Research, Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bradford O Parsons
- Leni and Peter W. May Departmentof Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paul J Cagle
- Leni and Peter W. May Departmentof Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Brochin RL, Zastrow R, Hussey-Andersen L, Parsons BO, Cagle PJ. Revision rotator cuff repair: a systematic review. J Shoulder Elbow Surg 2020; 29:624-633. [PMID: 31473134 DOI: 10.1016/j.jse.2019.06.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of revision rotator cuff repair (RCR) has increased along with the incidence of primary RCR over the past 2 decades. The purpose of this study was to perform a systematic review to analyze the clinical outcomes of revision RCR and chiefly to identify prognostic factors that may influence postoperative outcomes. METHODS The PubMed, MEDLINE (Ovid), Embase (Elsevier), and Cochrane Library (Wiley) databases were searched from database inception through November 2018 for studies assessing revision RCR. All studies were screened in duplicate for eligibility. Pooled analysis correlations between mean preoperative range-of-motion measures, American Shoulder and Elbow Surgeons (ASES) scores, and visual analog scale (VAS) pain scores and mean postoperative outcomes with revision RCR were examined via linear regression and reported with the strength of the Spearman correlation coefficient (rs). RESULTS A total of 22 studies met the inclusion criteria, including 3 level III and 19 level IV studies. Mean preoperative forward flexion had the greatest correlation with the mean postoperative ASES score (rs = 0.98). A strong positive correlation was also found between mean preoperative forward flexion and mean postoperative forward flexion (rs = 0.83). The mean preoperative VAS pain score was strongly correlated with the mean postoperative VAS pain score (rs = 0.88) and demonstrated a moderate negative association with the mean postoperative ASES score (rs = -0.48). Finally, the mean preoperative ASES score was moderately correlated with the mean postoperative ASES score (rs = 0.56). CONCLUSIONS The results of this systematic review demonstrate favorable clinical outcomes following RCR revision performed both in an open manner and arthroscopically. Preoperative forward flexion was identified as a possible prognostic factor for improved outcomes.
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Affiliation(s)
- Robert L Brochin
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Ryley Zastrow
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lindsay Hussey-Andersen
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Meaike JJ, Patterson DC, Anthony SG, Parsons BO, Cagle PJ. Soft tissue resurfacing for glenohumeral arthritis: a systematic review. Shoulder Elbow 2020; 12:3-11. [PMID: 32010227 PMCID: PMC6974882 DOI: 10.1177/1758573219849606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Severe glenohumeral arthritis in the young/active patient remains challenging. Historically, glenohumeral arthrodesis was recommended with limited return of function. Total shoulder arthroplasty has shown increasing survivorship at 15 years; however it is still not ideal for young patients. Biologic resurfacing of the glenoid with humeral head replacement has shown promising results. METHODS The PubMed and Embase databases were queried for studies evaluating outcomes of glenoid biologic resurfacing with autograft or allograft. Two independent reviewers performed a systematic review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. RESULTS Eleven studies (268 shoulders, 264 patients) were included. Minimum follow-up was 24 months in all but one study; patient age ranged from 14 to 75 years. Glenoid grafts used included 44.3% lateral meniscus allografts, 25.4% human acellular dermal matrix, 14.2% Achilles tendon allografts, 11.6% shoulder joint capsules, and 4.5% fascia lata autografts. Studies reported significantly improved American Shoulder and Elbow Surgeons, Visual Analog Scale, and Simple Shoulder Test scores postoperatively; 43.3% were failures (Neer's evaluation of unsatisfactory or requiring revision). Infection occurred in 12/235. CONCLUSIONS Biologic resurfacing of the glenoid with a metallic humeral component can provide a significant improvement in pain, motion, and standardized outcomes scores in the well-indicated situation. Appropriate counseling is required with an appreciated complication rate of over 36% and a revision rate of 34%.
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Affiliation(s)
- Joshua J Meaike
- Joshua J Meaike, Department of Orthopaedic
Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York
10029, NY, USA.
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Cagle PJ, London DA, Gluck MJ, Morel S, Parsons BO. Long head of biceps tenodesis at the superior aspect of the biceps groove: A biomechanical comparison of inlay and onlay techniques. Shoulder Elbow 2020; 12:12-17. [PMID: 32010228 PMCID: PMC6974887 DOI: 10.1177/1758573218815281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/01/2018] [Accepted: 10/20/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Pathology involving the long head of the biceps tendon is a common source of shoulder pain. Biceps tenodesis has been successfully used in areas below the pectoralis, above the pectoralis, and above the biceps groove. However, clinical data are lacking for additional techniques for tenodesis at the superior aspect of the biceps groove. METHODS A biomechanical comparison was completed examining six matched pairs of cadaveric shoulders. The ultimate load to failure was compared between an inlay and onlay biceps tenodesis at the superior aspect of the biceps groove. RESULTS The results demonstrate an average construct strength of 215 N for the inlay technique and 210 N for the onlay technique. The difference between the two techniques was not significant. CONCLUSIONS This study demonstrates similar biomechanical strength for both constructs.
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Affiliation(s)
- Paul J Cagle
- Paul J Cagle Jr, Icahn School of Medicine at
Mount Sinai, 425 West 59th Street, 5th Floor, New York, NY 10019, USA.
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Cagle PJ, Reizner W, Parsons BO. A technique for humeral prosthesis placement in reverse total shoulder arthroplasty for fracture. Shoulder Elbow 2019; 11:459-464. [PMID: 32269606 PMCID: PMC7094067 DOI: 10.1177/1758573218793904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 11/15/2022]
Abstract
Recent trends have illustrated the benefits of treating displaced fractures of the proximal humerus with reverse total shoulder arthroplasty. Clinical results have demonstrated reliable restoration of function in situations where results following hemiarthroplasty have been variable and difficult to predict. Data have demonstrated landmarks to assist with humeral stem height in hemiarthroplasty. However, intraoperative landmarks to guide placement of the humeral component in reverse shoulder arthroplasty have not been described. In this technique, the superior border of the pectoralis tendon is utilized. A distance of 5.0 cm is used to assist in placement of the most superior aspect of the metallic humeral component and with humeral stem version. This technique can be used as a guide to assist a treating physician in situations where bony fracture and comminution make humeral stem height placement difficult to judge.
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Affiliation(s)
- Paul J Cagle
- Paul J Cagle Jr, Icahn School of Medicine at
Mount Sinai, 425 West, 59th Street, 5th Floor, New York, NY 10019, USA.
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Keswani A, Chi D, Lovy AJ, London DA, Cagle PJ, Parsons BO, Bosco JA. Risk factors for and timing of adverse events after revision total shoulder arthroplasty. Shoulder Elbow 2019; 11:332-343. [PMID: 31534483 PMCID: PMC6739747 DOI: 10.1177/1758573218780517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/12/2018] [Accepted: 05/07/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Despite increasing rates of revision total shoulder arthroplasty (RTSA), there is a paucity of literature on optimizing perioperative outcomes. The purposes of this study were to identify risk factors for unplanned readmission and perioperative complications following RTSA, risk-stratify patients based on these risk factors, and assess timing of complications. METHODS Bivariate and multivariate analyses of risk factors were assessed on RTSA patients from the ACS-NSQIP database from 2011 to 2015. Patients were risk-stratified and timing of severe adverse events and cause of readmission were evaluated. RESULTS Of 809 RTSA patients, 61 suffered a perioperative complication or readmission within 30 days of discharge. Multivariate analysis identified operative time, BMI > 40, infection etiology, high white blood cell count, and low hematocrit as significant independent risk factors for 30-day complications or readmission after RTSA (p ≤ 0.05). Having at least one significant risk factor was associated with 2.71 times risk of complication or readmission within 15 days compared to having no risk factors (p < 0.001). The majority of unplanned readmission, return to the operating room, open/deep wound infection, and sepsis/septic shock occurred within two weeks of RTSA. DISCUSSION Patients at high risk of complications and readmission after RTSA should be identified and optimized preoperatively to improve outcomes and lower costs.
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Affiliation(s)
- Aakash Keswani
- Department of Orthopaedic Surgery, Mount
Sinai Hospital, New York, NY, USA
| | - Debbie Chi
- Department of Orthopaedic Surgery, Mount
Sinai Hospital, New York, NY, USA
- Debbie Chi, Department of Orthopaedic
Surgery, Mount Sinai Hospital, 5 East 98th St., New York, NY 10029, USA.
| | - Andrew J Lovy
- Department of Orthopaedic Surgery, Mount
Sinai Hospital, New York, NY, USA
| | - Daniel A London
- Department of Orthopaedic Surgery, Mount
Sinai Hospital, New York, NY, USA
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Mount
Sinai Hospital, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Mount
Sinai Hospital, New York, NY, USA
| | - Joseph A Bosco
- Department of Orthopaedic Surgery, NYU
Langone Medical Center, New York, NY, USA
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Zastrow RK, London DA, Parsons BO, Cagle PJ. Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears: A Systematic Review. Arthroscopy 2019; 35:2525-2534.e1. [PMID: 31395196 DOI: 10.1016/j.arthro.2019.02.053] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/10/2019] [Accepted: 02/24/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the preliminary clinical outcomes and complications of superior capsule reconstruction (SCR) for irreparable rotator cuff tears. METHODS A systematic review of PubMed, MEDLINE, EMBASE, and Cochrane databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical outcomes of irreparable rotator cuff tears managed by SCR were included. Clinical outcome analyses of pre- and postoperative range of motion, American Shoulder and Elbow Surgeons scores, visual analog scale pain scores, and acromiohumeral intervals (AHIs) were performed and reported as range or frequency. RESULTS Five studies (285 patients, 291 shoulders) of level III-IV evidence were included, with a weighted mean (± standard deviation) follow-up of 27.7 ± 17.3 months. Forward flexion improved from 91°-130° preoperatively to 147°-160° postoperatively, external rotation from 26°-41° to 41°-45°, and internal rotation from L4-L1 to L1. American Shoulder and Elbow Surgeons scores increased from 36-52.2 to 77.5-92, and visual analog scale pain scores decreased from 4.0-6.3 to 0.4-1.7. Radiographically, AHIs with acellular dermal allograft ranged from 4.5 to 7.1 mm preoperatively, improving to 7.6-10.8 mm immediately postoperation before decreasing to 6.7-9.7 mm by final follow-up. Complication and graft failure rates were 17.2% and 11.7%, respectively. CONCLUSIONS Preliminary results of SCR show consistent improvement in shoulder functionality and pain reduction. However, a decrease in postoperative AHIs indicates dermal allograft elongation and persistent superior migration of the humerus, potentially contributing to later graft failure. Studies with longer follow-up will be essential to evaluate the long-term utility of SCR in the treatment of irreparable rotator cuff tears. LEVEL OF EVIDENCE Level IV, systematic review of level III-IV studies.
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Affiliation(s)
- Ryley K Zastrow
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A..
| | - Daniel A London
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A
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Cagle PJ, Werner B, Shukla DR, London DA, Parsons BO, Millar NL. Interobserver and intraobserver comparison of imaging glenoid morphology, glenoid version and humeral head subluxation. Shoulder Elbow 2019; 11:204-209. [PMID: 31210792 PMCID: PMC6555109 DOI: 10.1177/1758573218768507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 02/04/2018] [Accepted: 02/07/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Glenoid morphology, glenoid version and humeral head subluxation represent important parameters for the treating physician. The most common method of assessing glenoid morphology is the Walch classification which has only been validated with computed tomography (CT). METHODS CT images and magnetic resonance imaging (MRI) images of 25 patients were de-identified and randomized. Three reviewers assessed the images for each parameter twice. The Walch classification was assessed with a weighted kappa value. Glenoid version and humeral head subluxation were comparted with a reproducibility coefficient. RESULTS The Walch classification demonstrated almost perfect intraobserver agreement for MRI and CT images (k = 0.87). Weighted interobserver agreement values for the Walch classification were fair for CT and MRI (k = 0.34). The weighted reproducibility coefficient for glenoid version measured 9.13 (CI 7.16-12.60) degrees for CT and 13.44 (CI 10.54-18.55) degrees for MRI images. The weighted reproducibility coefficient for percentage of humeral head subluxation was 17.43% (CI 13.67-24.06) for CT and 18.49% (CI 14.5-25.52) for MRI images. DISCUSSION CT and MRI images demonstrated similar efficacy in classifying glenoid morphology, measuring glenoid version and measuring posterior humeral head subluxation. MRI can be used as an alternative to CT for measuring these parameters.
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Affiliation(s)
- Paul J Cagle
- Rhön-Klinikum AG, Bad Neustadt an der Saale, Germany,Paul J Cagle, Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine, Mount Sinai Medical Center, Mount Sinai West Hospital, 1000 Tenth Avenue, Suite 3A-35, New York, NY 10019, USA.
| | - Birgit Werner
- Rhön-Klinikum AG, Bad Neustadt an der Saale, Germany
| | - Dave R Shukla
- Newport Orthopaedic Institute (affiliated with the Mayo Clinic), Newport Beach, USA
| | - Daniel A London
- Icahn School of Medicine at Mount Sinai Hospital, New York, USA
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Denard PJ, Provencher MT, Lädermann A, Romeo AA, Parsons BO, Dines JS. Version and inclination obtained with 3-dimensional planning in total shoulder arthroplasty: do different programs produce the same results? JSES Open Access 2018; 2:200-204. [PMID: 30675595 PMCID: PMC6334884 DOI: 10.1016/j.jses.2018.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Our purpose was to compare the output of glenoid measurements with 2 commercially available preoperative 3-dimensional (3D) total shoulder arthroplasty planning systems. The hypothesis was that there would be no difference in product-derived measurements between the systems. Methods Preoperative 3D computed tomography scans of 63 consecutive patients undergoing primary arthroplasty were analyzed using 2 product-derived techniques: Blueprint and VIP. Glenoid version and inclination measurements with each system were blinded and statistically compared, and the amount of variance was recorded. Results Glenoid version based on Blueprint was -10.9° ± 9.0° (range, -41° to 14°) compared with -9.3° ± 8.2° (range, -36° to 8°) for VIP (P = .04). Inclination was 9.0° ± 8.8° (range, -12° to 29°) with Blueprint compared with 9.7° ± 6.1° (range, -6° to 22°) for VIP (P = .463). For version, the difference between the 2 systems was less than 5° in 44 cases (69.8%), 5°-10° in 12 cases (19.0%), and greater than 10° in 7 cases (11.1%). For inclination, the difference was less than 5° in 34 cases (54.0%), 5°-10° in 17 cases (27.0%), and greater than 10° in 12 cases (19.0%). We found no differences in glenoid version or inclination based on glenoid morphology between the 2 systems (P = .908) and no differences between patients with the most severe arthritis and posterior wear (P = .202). Conclusions There is considerable variability between preoperative measurements obtained for 3D planning of shoulder arthroplasty with the use of Blueprint and VIP. Given that implant choice and desired component positioning are based on preoperative measurements, further study is needed to evaluate the differences between the measurements obtained with different techniques.
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Affiliation(s)
- Patrick J. Denard
- Southern Oregon Orthopedics, Medford, OR, USA
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
- Corresponding author: Patrick J. Denard, MD, Southern Oregon Orthopedics, 2780 E. Barnett Road, Suite 200, Medford, OR 97504.
| | | | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | | | - Bradford O. Parsons
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Sochol KM, Charen DA, Andelman SM, Parsons BO. Cutaneous metallosis following reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27:e230-e233. [PMID: 29724672 DOI: 10.1016/j.jse.2018.02.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 02/28/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Kristen M Sochol
- Department of Orthopedics, Mount Sinai Hospital, New York, NY, USA.
| | - Daniel A Charen
- Department of Orthopedics, Mount Sinai Hospital, New York, NY, USA
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Neviaser AS, Patterson DC, Cagle PJ, Parsons BO, Flatow EL. Anatomic landmarks for arthroscopic suprapectoral biceps tenodesis: a cadaveric study. J Shoulder Elbow Surg 2018; 27:1172-1177. [PMID: 29500072 DOI: 10.1016/j.jse.2018.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 12/27/2017] [Accepted: 01/07/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Biceps tenodesis reduces the incidence of Popeye deformity occurring with tenotomy, but pain may occur with tenodesis superior to or within the bicipital groove. Arthroscopic suprapectoral tenodesis is an attractive alternative. The purpose of this study was to establish landmarks for arthroscopic suprapectoral tenodesis and determine the appropriate fixation point to optimize muscle tension. METHODS Twelve fresh cadaveric shoulders were dissected. Urethane polymer was injected into the axillary artery. The position of the anterior branch of the axillary nerve was marked. The transverse humeral ligament was split, exposing the biceps (long head of the biceps [LHB]) from its origin to the pectoralis major tendon (PMT). The intra-articular portion was released. Measurements were taken from the proximal tendon to described landmarks. RESULTS The mean length of the intra-articular LHB was 2.53 cm (range, 1.72-3.55 cm). The mean distance from the LHB origin to the inferior lesser tuberosity (LT) was 5.58 cm (range, 4.02-6.87 cm), and that to the superior border of the PMT was 8.46 cm (range, 6.46-10.78 cm). The suprapectoral tenodesis zone (inferior LT to superior PMT) was 2.96 cm (range, 1.54-4.40 cm). In all specimens, a branch of the anterior humeral circumflex arose medial to the LHB and distal to the LT and crossed the suprapectoral zone from medial to lateral at 1.49 ± 0.42 cm proximal to the PMT, approximately at the level of the axillary nerve. The musculocutaneous nerve was on average 3.06 cm (range, 1.86-3.76 cm) from the tenodesis zone. CONCLUSION A branch of the anterior humeral circumflex is a reliable landmark for identifying the mid-suprapectoral zone. The distance from the proximal LHB tendon to this crossing vessel averaged 6.32 cm in female specimens and 8.28 cm in male specimens. These findings allow appropriate tensioning of the LHB during arthroscopic suprapectoral tenodesis.
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Affiliation(s)
- Andrew S Neviaser
- Department of Orthopaedic Surgery, Ohio State University, Columbus, OH, USA
| | - Diana C Patterson
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA.
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
| | - Evan L Flatow
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
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Cagle PJ, Olujimi V, Parsons BO. Arthroscopic Treatment of Labral Tears: A Critical Analysis Review. JBJS Rev 2018; 6:e4. [PMID: 29634588 DOI: 10.2106/jbjs.rvw.17.00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Paul J Cagle
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY
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Denard PJ, Lederman E, Parsons BO, Romeo AA. Finite element analysis of glenoid-sided lateralization in reverse shoulder arthroplasty. J Orthop Res 2017; 35:1548-1555. [PMID: 27533921 DOI: 10.1002/jor.23394] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/09/2016] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to evaluate glenoid-sided lateralization in reverse shoulder arthroplasty (RSA), and compare bony and prosthetic lateralization. The hypothesis was that stress and displacement would increase with progressive bony lateralization, and be lower with prosthetic lateralization. A 3D finite element analysis (FEA) was performed on a commercially available RSA prosthesis. Stress and displacement were evaluated at baseline and following 5, 10, and 15 mm of bony or prosthetic lateralization. Additional variables included glenosphere size, baseplate orientation, and peripheral screw orientation. Maximum stress for a 36 mm glenosphere without bone graft increased by 137% for the 5 mm graft, 187% for the 10 mm graft, and 196% for the 15 mm graft. Likewise, displacement progressively increased with increasing graft thickness. Stress and displacement were reduced with a smaller glenosphere, inferior tilt of the baseplate, and divergent peripheral screws. Compared to bony lateralization, stress was lower with prosthetic lateralization through the glenosphere or baseplate. Displacement with 5 mm of bony lateralization reached recommended maximal amounts for osseous integration, whereas, this level was not reached until 10-15 mm of prosthetic lateralization. Baseplate stress and displacement in an FEA model is lower with a smaller glenosphere, inferior tilt, and divergent screws. Bony lateralization increases stress and displacement to a greater degree than prosthetic lateralization. It appears that at least 10 mm of prosthetic lateralization is mechanically acceptable during RSA, but only 5 mm of bony lateralization is advised. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1548-1555, 2017.
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Affiliation(s)
- Patrick J Denard
- Southern Oregon Orthopedics, Medford, Oregon.,Department of Orthopaedic and Rehabilitation, Oregon Health and Science University, Portland, Oregon
| | - Evan Lederman
- The Orthopedic Clinic Association, Phoenix, Arizona.,Department of Orthopedic Surgery, Banner University Medical Center, Phoenix, Arizona
| | - Bradford O Parsons
- Leni and Peter W. May Department of Orthopaedic Surgery at the Icahn School of Medicine at Mount Sinai, New York, New York
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Shukla DR, Rubenstein WJ, Barnes LA, Klion MJ, Gladstone JN, Kim JM, Cleeman E, Forsh DA, Parsons BO. The Influence of Incision Type on Patient Satisfaction After Plate Fixation of Clavicle Fractures. Orthop J Sports Med 2017; 5:2325967117712235. [PMID: 28680896 PMCID: PMC5484427 DOI: 10.1177/2325967117712235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Open reduction and internal fixation (ORIF) of the clavicle is a common procedure that has been shown to have improved outcomes over nonoperative treatment. Several incisions can be used to approach clavicle fractures, the decision of which is variable among surgeons. PURPOSE To compare patient satisfaction and subjective outcomes between patients with a longitudinal incision versus those with a necklace incision for the treatment of diaphyseal clavicle fractures. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Thirty-six patients with a diaphyseal clavicle fracture (Orthopaedic Trauma Association type 15-B) were treated by 1 of 7 orthopaedic surgeons. The intervention was ORIF with anatomic contoured plates. Patients were divided into a necklace incision group and a longitudinal incision group depending on the surgical approach used. Medical records were reviewed, and participants completed an online survey with questions related to pain, numbness, scar appearance, and satisfaction. Function was assessed using the American Shoulder and Elbow Surgeons score. Statistical significance was determined with P < .05. RESULTS There were 16 patients in the necklace incision group and 20 in the longitudinal incision group. Patients in the necklace incision group were significantly more satisfied with the appearance of their scars (P = .01), which correlated with overall satisfaction (P = .05). There were no differences in overall satisfaction, pain, numbness, or reoperation rates for hardware removal between the necklace (6%) and longitudinal groups (15%). CONCLUSION Patients undergoing clavicle ORIF with a necklace incision are more satisfied with their scar appearance than those with a longitudinal incision. The overall satisfaction, rate of numbness, and plate removal were similar in both groups.
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Affiliation(s)
- Dave R. Shukla
- Leni & Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William J. Rubenstein
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- William J. Rubenstein, BA, Icahn School of Medicine at Mount Sinai, 50 East 98th Street 2B, New York, NY 10029, USA ()
| | - Leslie A. Barnes
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark J. Klion
- Leni & Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James N. Gladstone
- Leni & Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jaehon M. Kim
- Leni & Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Edmond Cleeman
- Leni & Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David A. Forsh
- Leni & Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bradford O. Parsons
- Leni & Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Lovy AJ, Keswani A, Beck C, Dowdell JE, Parsons BO. Risk factors for and timing of adverse events after total shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:1003-1010. [PMID: 28111178 DOI: 10.1016/j.jse.2016.10.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/28/2016] [Accepted: 10/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) is a likely target for future bundled payment initiatives, necessitating accurate preoperative risk stratification. The purpose of this study was to identify risk factors for unplanned readmission and severe adverse events, to risk stratify TSA patients based on these risk factors, and to assess timing of complications after TSA. METHODS Data were collected from patients undergoing TSA from 2009 to 2014 in the American College of Surgeons National Surgical Quality Improvement Program. Bivariate and multivariate analyses of risk factors for severe adverse events or readmission were assessed. Patients were risk stratified, and timing of severe adverse events and cause of readmission were evaluated. RESULTS The analysis included 5801 TSA patients; 146 (2.5%) suffered severe adverse events, and 158 (2.7%) had a 30-day unplanned readmission. The most common severe adverse events were reoperation (40%), thrombolic event (deep venous thrombosis or pulmonary embolism; 14%), cardiac event (10%), and death (8.2%). Pneumonia (8.9%) and thrombolic event (7.6%) were the most common medically related causes, whereas dislocation (7.6%) and postoperative infection or wound complication (5.1%) were the most common surgical causes for readmission. Multivariate analysis identified inflammatory arthritis (P = .026), male gender (P = .019), age (P < .001), functional status (P = .024), and American Society of Anesthesiologists class 3/4 (P = .01) as independent predictors for unplanned 30-day readmission and all but inflammatory arthritis for severe adverse events (P ≤ .05 for all). Patients with ≥3 risk factors had an 11.56 (P = .002) and 3.43 (P = .013) times increased odds of unplanned readmission and severe adverse events occurring within 2 weeks after surgery, respectively, compared with patients with 0 risk factors. CONCLUSIONS Patients at high risk of TSA complications and readmission should be identified preoperatively to improve outcomes and to lower costs. Bundled payment initiatives must account for both patient- and procedure-related risk factors.
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Affiliation(s)
- Andrew J Lovy
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA.
| | - Aakash Keswani
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Christina Beck
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - James E Dowdell
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
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Patterson DC, Shin JI, Andelman SM, Olujimi V, Parsons BO. Increased risk of 30-day postoperative complications for diabetic patients following open reduction-internal fixation of proximal humerus fractures: an analysis of 1391 patients from the American College of Surgeons National Surgical Quality Improvement Program database. JSES Open Access 2017; 1:19-24. [PMID: 30675534 PMCID: PMC6340826 DOI: 10.1016/j.jses.2017.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Prior database studies have shown that complication rates following surgical treatment of proximal humerus fractures are low. However, diabetes has been shown across orthopedics to have significantly increased risks of postoperative complications. The purpose of our study was to identify complications for which diabetic patients are at increased risk following operative treatment of proximal humerus fractures. Methods The National Surgical Quality Improvement Program database from 2005 to 2014 identified patients >18 years undergoing open reduction-internal fixation for proximal humerus fractures. Patients with incomplete perioperative data were excluded. Patients with non–insulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM) were compared with nondiabetic patients using multivariate logistic regression analysis. Odds ratio (OR) was calculated with a 95% confidence interval, and the significance level was held at P < .05. Results There were 1391 patients identified; 1147 (82%) were not diabetic, 91 (7%) had IDDM, and 153 (11%) had NIDDM. Of these, 39.68% (550) were obese (body mass index >30.0). Hypertension, dyspnea, and chronic obstructive pulmonary disease were the most frequent concurrent patient factors in diabetic patients. Postoperatively, patients with diabetes had a statistically significant higher risk of pneumonia (OR, 217.80; P = .002) and length of stay >4 days (OR, 2.05; P = .010). Among diabetics, non–insulin-dependent diabetics had a greater risk of sepsis (OR, 25.84; P = .022) and pneumonia (OR, 12.19; P = .013) than insulin-dependent diabetics. Conclusion Both NIDDM and IDDM were associated with a number of adverse postoperative events. Importantly, NIDDM was found to be an independent risk factor for postoperative sepsis and pneumonia, whereas IDDM was identified as an independent risk factor for pneumonia and prolonged length of stay (≥4 days).
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Affiliation(s)
- Diana C Patterson
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA
| | - John I Shin
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA
| | - Steven M Andelman
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA
| | - Victor Olujimi
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA
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Howard DR, Kazemi N, Rubenstein WJ, Hartwell MJ, Poeran J, Chang AL, Podolnick JD, Parsons BO, Galatz LM, Flatow EL. Cost-benefit analysis of routine pathology examination in primary shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:674-678. [PMID: 28277257 DOI: 10.1016/j.jse.2016.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/21/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The annual number of shoulder arthroplasty procedures is continuing to increase. Specimens from shoulder arthroplasty cases are routinely sent for pathologic examination. This study sought to evaluate the clinical utility and associated costs of routine pathologic examination of tissue removed during primary shoulder arthroplasty cases and to determine cost-effectiveness of this practice. METHODS This is a retrospective review of primary shoulder arthroplasty cases. Patients whose humeral head was sent for routine pathologic examination were included. Cases were determined to have concordant, discrepant, or discordant diagnoses based on preoperative/postoperative diagnosis and pathology diagnosis. Costs were estimated in 2015 U.S. dollars, and cost-effectiveness was determined by the cost per discrepant diagnosis and cost per discordant diagnosis. RESULTS We identified 714 cases of primary shoulder arthroplasty in 646 patients who met inclusion criteria. The prevalence of concordant diagnoses was 94.1%, the prevalence of discrepant diagnoses was 5.9%, and no cases had discordant diagnoses. There were 172 cases that had biceps tendon specimens sent for pathology examination, and none led to a change in patient care. Total estimated costs were $77,309.34 in 2015 U.S. dollars. Cost per discrepant diagnosis for humeral head specimens was $1424.09, and cost per discordant diagnosis is at least $59,811.78. DISCUSSION/CONCLUSION Primary shoulder arthroplasty has a high rate of concordant diagnosis. Discrepant diagnoses were 5.9% in our study, and there were no discordant diagnoses. This study showed limited clinical utility in routinely sending specimens from primary shoulder arthroplasty cases for pathology examination, and calculation using a traditional life-year value of $50,000 showed that the standard for cost-effectiveness is not met.
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Affiliation(s)
- Daniel R Howard
- Department of Orthopedic Surgery, Mount Sinai St. Luke's-Roosevelt Hospital, New York, NY, USA.
| | - Namdar Kazemi
- Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William J Rubenstein
- Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew J Hartwell
- Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andy L Chang
- Department of Orthopedic Surgery, Mount Sinai St. Luke's-Roosevelt Hospital, New York, NY, USA
| | - Jeremy D Podolnick
- Department of Orthopedic Surgery, Mount Sinai St. Luke's-Roosevelt Hospital, New York, NY, USA
| | - Bradford O Parsons
- Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leesa M Galatz
- Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan L Flatow
- Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Shukla DR, McAnany S, Pean C, Overley S, Lovy A, Parsons BO. The results of tension band rotator cuff suture fixation of locked plating of displaced proximal humerus fractures. Injury 2017; 48:474-480. [PMID: 28063677 DOI: 10.1016/j.injury.2016.12.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/17/2016] [Accepted: 12/26/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to assess 1-year outcomes of patients with displaced proximal humerus fractures who underwent treatment with locked plate fixation with rotator cuff suture augmentation. METHODS A total of 86 patients who had sustained 2, 3 and 4-part displaced proximal humerus fractures underwent locked plate fixation with multiple sutures placed in the cuff tendons. Clinical outcome variables included active forward elevation (AFE), active external rotation (AER), and Constant and American Shoulder and Elbow Surgeons (ASES) scores. Post-operative variables included the following complications: varus re-collapse, loss of fixation, osteonecrosis of the humeral head (AVN), screw cut out, hardware failure and infection. RESULTS Forty-one patients were available with minimum of 1-year follow-up. Mean AFE was 142±17.0° and AER was 41±13.0°. The overall complication rate was 14.6%, with osteonecrosis being the most common (12.2%). Of the 21 patients (51.2%) that initially had varus displacement, all but one maintained anatomic reduction and fixation. Mean ASES score was 78.2±20.0 and average Constant score was 72.7±17.6. Bivariate analyses demonstrated that pre-operative medial comminution (p=0.297) or varus collapse (p=0.95) were not associated with an increased likelihood of sustaining a complication. CONCLUSIONS Follow-up of patients in this series demonstrated a low overall complication rate and excellent functional outcomes. We believe suture augmentation of the rotator cuff can counteract varus forces on proximal humerus fractures fixed with locked plates, and should be performed routinely in displaced 2, 3 and 4 part fractures.
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Affiliation(s)
- Dave R Shukla
- Leni & Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY 10029, United States.
| | - Steven McAnany
- Leni & Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY 10029, United States
| | - Christian Pean
- Icahn School of Medicine at Mount Sinai, 50 East 98th Street, Apt 2B, New York, NY 10029, United States
| | - Samuel Overley
- Leni & Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY 10029, United States
| | - Andrew Lovy
- Leni & Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY 10029, United States
| | - Bradford O Parsons
- Leni & Peter May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY 10029, United States
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Shukla DR, McAnany S, Kim J, Overley S, Parsons BO. Hemiarthroplasty versus reverse shoulder arthroplasty for treatment of proximal humeral fractures: a meta-analysis. J Shoulder Elbow Surg 2016; 25:330-40. [PMID: 26644230 DOI: 10.1016/j.jse.2015.08.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND We performed a meta-analysis of studies with at least Level IV evidence to compare outcomes between hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures. METHODS Three electronic databases (PubMed, Cochrane, and EMBASE) were searched. The quality of each study was investigated, and data on radiographic and functional outcomes were extracted and analyzed. RESULTS The analysis included 1 Level I study, 1 Level II study, 3 Level III studies, and 2 Level IV studies. Reverse shoulder arthroplasty was more favorable than hemiarthroplasty in forward elevation (P < .001), abduction (P < .001), tuberosity healing (P = .002), Constant score (P < .001), American Shoulder and Elbow Surgeons score (P < .001), and Disabilities of the Arm, Shoulder and Hand score (P = .001). Only external rotation (P = .85) was not in favor of reverse shoulder arthroplasty. CONCLUSIONS The available literature suggests that reverse shoulder arthroplasty performed to address complex proximal humeral fractures might result in more favorable clinical outcomes than hemiarthroplasty performed for the same indication.
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Affiliation(s)
- Dave R Shukla
- Leni & Peter May Department of Orthopaedics, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Steven McAnany
- Leni & Peter May Department of Orthopaedics, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun Kim
- Leni & Peter May Department of Orthopaedics, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sam Overley
- Leni & Peter May Department of Orthopaedics, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Leni & Peter May Department of Orthopaedics, Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
Several types of elbow fractures are amenable to arthroscopic or arthroscopic-assisted fracture fixation, including fractures of the coronoid, radial head, lateral condyle, and capitellum. Other posttraumatic conditions may be treated arthroscopically, such as arthrofibrosis or delayed radial head excision. Arthroscopy can be used for assessment of stability or intra-articular fracture displacement. The safest portals are the midlateral (soft spot portal), proximal anteromedial, and proximal anterolateral. Although circumstances may vary according to the injury pattern, a proximal anteromedial portal is usually established first. Arthroscopy enables a less invasive surgical exposure that facilitates visualization of the fracture fragments in select scenarios.
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Affiliation(s)
- Leslie A Fink Barnes
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10029, USA
| | - Bradford O Parsons
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10029, USA.
| | - Michael Hausman
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10029, USA
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Obermeyer T, Cagle PJ, Parsons BO, Flatow EL. Midterm Follow-Up of Metal-Backed Glenoid Components in Anatomical Total Shoulder Arthroplasties. Am J Orthop (Belle Mead NJ) 2015; 44:E340-E342. [PMID: 26372761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Loosening of the glenoid remains one of the most common complications of total shoulder arthroplasty (TSA) and is the most cited reason for performing revision arthroplasty. Ingrowth metal-backed glenoid components offer the theoretical advantage of bone growth directly into the prosthesis with a single host-prosthesis interface. In the study reported here, we retrospectively reviewed the charts of patients who had TSAs performed by 2 fellowship-trained shoulder surgeons using glenoid components with porous tantalum anchors. Standard radiographs were analyzed for lucency surrounding the anchors. Before and after surgery, American Shoulder and Elbow Surgeons (ASES) scores and active forward elevation (AFE) and active external rotation (AER) measurements were recorded. Twelve shoulders (11 patients) were examined. Mean follow-up was 20 months. In all cases, radiographs showed no glenoid lucency. Mean AFE and mean AER both increased significantly (P < .01), as did postoperative ASES scores (P < .01). Porous tantalum ingrowth glenoid components show no radiographic or clinical evidence of loosening at midterm follow-up. Long-term studies are needed to determine if these midterm outcomes are maintained and provide benefit over conventional cemented polyethylene designs.
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Affiliation(s)
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL.
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