This paper presents an ongoing review of the use of a wedge-shaped porous metal augments in the shoulder to address glenoid retroversion as part of
Introduction. Despite the positive outcomes in shoulder joint replacements in the last two decades, polyethylene wear debris in metal-on-polyethylene artificial shoulder joints is well-known as a limitation in the long-term survival of shoulder arthroplasties systems. Consequently, there is an interest in the use of novel materials as an alternative to hard bearing surfaces such as pyrolytic carbon layer (PyroCarbon). Materials and Methods. In the present study, the unique Newcastle Shoulder Wear Simulator was used (Smith et al., 2015; Smith et al., 2016) to evaluate the wear behavior of four commercially available PyroCarbon humeral heads 43 mm diameter, articulating against conventional ultra-high molecular weight polyethylene (UHMWPE) glenoid inserts with a radius of curvature of 17.5 mm to form an
INTRODUCTION. Preoperative planning software for
INTRODUCTION. 3D preoperative planning software for
The clinical impact of radiolucent glenoid lines is controversial, where the presence of a radiolucent glenoid lines has been suggested to be an indicator of clinical glenoid loosening. The goal of this database analysis is to quantify and compare the pre- and post-operative outcomes of 427 patients who received a primary aTSA with one specific prosthesis and were sorted based upon the radiographic presence of a radiolucent glenoid line at latest clinical followup. 427 patients (mean age: 67.0yrs) with an average follow-up of 49.4 months was treated with aTSA for OA by 14 fellowship trained orthopaedic surgeons. Of these 427 patients, 293 had a cemented keel glenoids (avg follow-up = 50.8 months) and 134 had a cemented pegged glenoids (avg follow-up = 48.7 months). Cemented peg and keel glenoid patients were analyzed separately and also combined into 1 cohort: 288 patients (158 female, avg: 68.7 yrs; 130 male, avg: 64.9 yrs) did not have a radiolucent glenoid line (avg follow-up = 46.9 months); whereas, 139 patients (83 female, avg: 68.5 yrs; 56 male, avg: 64.6 yrs) had a radiolucent glenoid line (avg follow-up = 54.4 months). Outcomes were scored using SST, UCLA, ASES, Constant, and SPADI metrics; active ROM also measured. A two-tailed, unpaired t-test identified differences (p<0.05) in pre-operative, post-operative, and pre-to-post improvements.Introduction
Methods
Machine learning is a relatively novel method to orthopaedics which can be used to evaluate complex associations and patterns in outcomes and healthcare data. The purpose of this study is to utilize 3 different supervised machine learning algorithms to evaluate outcomes from a multi-center international database of a single shoulder prosthesis to evaluate the accuracy of each model to predict post-operative outcomes of both aTSA and rTSA. Data from a multi-center international database consisting of 6485 patients who received primary total shoulder arthroplasty using a single shoulder prosthesis (Equinoxe, Exactech, Inc) were analyzed from 19,796 patient visits in this study. Specifically, demographic, comorbidity, implant type and implant size, surgical technique, pre-operative PROMs and ROM measures, post-operative PROMs and ROM measures, pre-operative and post-operative radiographic data, and also adverse event and complication data were obtained for 2367 primary aTSA patients from 8042 visits at an average follow-up of 22 months and 4118 primary rTSA from 11,754 visits at an average follow-up of 16 months were analyzed to create a predictive model using 3 different supervised machine learning techniques: 1) linear regression, 2) random forest, and 3) XGBoost. Each of these 3 different machine learning techniques evaluated the pre-operative parameters and created a predictive model which targeted the post-operative composite score, which was a 100 point score consisting of 50% post-operative composite outcome score (calculated from 33.3% ASES + 33.3% UCLA + 33.3% Constant) and 50% post-operative composite ROM score (calculated from S curves weighted by 70% active forward flexion + 15% internal rotation score + 15% active external rotation). 3 additional predictive models were created to control for the time required for patient improvement after surgery, to do this, each primary aTSA and primary rTSA cohort was subdivided to only include patient data follow-up visits >20 months after surgery, this yielded 1317 primary aTSA patients from 2962 visits at an average follow-up of 50 months and 1593 primary rTSA from 3144 visits at an average follow-up of 42 months. Each of these 6 predictive models were trained using a random selection of 80% of each cohort, then each model predicted the outcomes of the remaining 20% of the data based upon the demographic, comorbidity, implant type and implant size, surgical technique, pre-operative PROMs and ROM measures inputs of each 20% cohort. The error of all 6 predictive models was calculated from the root mean square error (RMSE) between the actual and predicted post-op composite score. The accuracy of each model was determined by subtracting the percent difference of each RMSE value from the average composite score associated with each cohort.Introduction
Methods
The 2021 Australian Orthopaedic Association National Joint Replacement Registry report indicated that total shoulder replacement using both mid head (TMH) length humeral components and reverse arthroplasty (RTSA) had a lower revision rate than stemmed humeral components in
Background. Stemless prostheses are recognized to be an effective solution for
A reverse total shoulder arthroplasty (RSA) is frequently performed in the revision setting. The purpose of this study was to report the clinical outcomes and complication rates following revision RSA (RRSA) stratified according to the primary shoulder procedure undergoing revision, including failed hemiarthroplasty (HA),
Experience has demonstrated in the hip and knee, related to total joint replacement arthroplasty, polymethyl methacrylate cement fixation can provide problems in terms of loosening, fragmentation, particulate wear and ultimate failure. These same problems have been recognised in total shoulder arthroplasty related to cement fixation of the glenoid. While cement fixation of the humeral component has proven much less problematic, there has been a swelling towards avoidance of using cement to secure the humeral component for fear of difficulty if revision is required. Surprisingly, with the high incidence of lucent lines, bone resorption and frank loosening, representing the most common source of failure in total shoulder arthroplasty, cementless fixation of the glenoid has not been, until now, embraced. The advent of reverse total shoulder arthroplasty has demonstrated the ability for secure cementless fixation to provide long-lasting secure implant retention in implants which have inherently higher shear and stress forces passing through the implant/bone interface. In
Patients over 70 years old have subclinical or impending rotator cuff dysfunction, raising concern about TSA in this population. The purpose of this study is to examine whether reverse total shoulder arthroplasty (RTSA) should be considered for the treatment of glenohumeral osteoarthritis in the presence of an intact rotator cuff (GHOA+IRC in patients older than 70 years of age. Twenty-five elderly (>70 years) patients at least one year status-post RTSA for GHOA+IRC were matched via age, sex, body mass index, smoking status, and whether the procedure involved the dominant extremity with 25 GHOA+IRC patients who received
Introduction. Previous hemodynamics studies in shoulder arthroplasty only evaluated Western population and mainly focused on risk factors of transfusion. However, Asians are relatively small, and have higher bleeding risk due to prothrombin-clotting-factor polymorphisms. Therefore, it is not appropriate to apply the results of previously studies directly to Asians. Authors compare different hemodynamics depending on the types of shoulder arthroplasties, and evaluate predictors for transfusion in Asian population. Methods. Total 212 shoulder arthroplasties (26 fracture hemiarthroplasty (fHA), 49
Body exhaust suits or surgical helmet systems (colloquially, ‘space suits’) are frequently used in many forms of arthroplasty, with the aim of providing personal protection to surgeons and, perhaps, reducing periprosthetic joint infections, although this has not consistently been borne out in systematic reviews and registry studies. To date, no large-scale study has investigated whether this is applicable to shoulder arthroplasty. We used the New Zealand Joint Registry to assess whether the use of surgical helmet systems was associated with lower all-cause revision or revision for deep infection in primary shoulder arthroplasties. We analyzed 16,000 shoulder arthroplasties (hemiarthroplasties, anatomical, and reverse geometry prostheses) recorded on the New Zealand Joint Registry from its inception in 2000 to the present day. We assessed patient factors including age, BMI, sex, and American Society of Anesthesiologists (ASA) grade, as well as whether or not the operation took place in a laminar flow operating theatre.Aims
Methods
The survival of humeral hemiarthroplasties in patients with relatively intact glenoid cartilage could theoretically be extended by minimizing the associated postoperative glenoid erosion. Ceramic has gained attention as an alternative to metal as a material for hemiarthroplasties because of its superior tribological properties. The aim of this study was to assess the in vitro wear performance of ceramic and metal humeral hemiarthroplasties on natural glenoids. Intact right cadaveric shoulders from donors aged between 50 and 65 years were assigned to a ceramic group (n = 8, four male cadavers) and a metal group (n = 9, four male cadavers). A dedicated shoulder wear simulator was used to simulate daily activity by replicating the relevant joint motion and loading profiles. During testing, the joint was kept lubricated with diluted calf serum at room temperature. Each test of wear was performed for 500,000 cycles at 1.2 Hz. At intervals of 125,000 cycles, micro-CT scans of each glenoid were taken to characterize and quantify glenoid wear by calculating the change in the thickness of its articular cartilage.Aims
Methods
It is important to understand the rate of complications associated with the increasing burden of revision shoulder arthroplasty. Currently, this has not been well quantified. This review aims to address that deficiency with a focus on complication and reoperation rates, shoulder outcome scores, and comparison of anatomical and reverse prostheses when used in revision surgery. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review was performed to identify clinical data for patients undergoing revision shoulder arthroplasty. Data were extracted from the literature and pooled for analysis. Complication and reoperation rates were analyzed using a meta-analysis of proportion, and continuous variables underwent comparative subgroup analysis.Aims
Methods
The aim of this study was to determine whether there is a correlation between the grade of humeral osteoarthritis (OA) and the severity of glenoid morphology according to Walch. We hypothesized that there would be a correlation. Overal, 143 shoulders in 135 patients (73 females, 62 males) undergoing shoulder arthroplasty surgery for primary glenohumeral OA were included consecutively. Mean age was 69.3 years (47 to 85). Humeral head (HH), osteophyte length (OL), and morphology (transverse decentering of the apex, transverse, or coronal asphericity) on radiographs were correlated to the glenoid morphology according to Walch (A1, A2, B1, B2, B3), glenoid retroversion, and humeral subluxation on CT images.Aims
Methods
Purpose:. Glenoid loosening persists as a common cause of
The Mathys Affinis Short is the most frequently used stemless total shoulder prosthesis in the UK. The purpose of this prospective cohort study is to report the survivorship, clinical, and radiological outcomes of the first independent series of the Affinis Short prosthesis. From January 2011 to January 2019, a total of 141 Affinis Short prostheses were implanted in 127 patients by a single surgeon. Mean age at time of surgery was 68 (44 to 89). Minimum one year and maximum eight year follow-up (mean 3.7 years) was analyzed using the Oxford Shoulder Score (OSS) at latest follow-up. Kaplan-Meier survivorship analysis was performed with implant revision as the endpoint. Most recently performed radiographs were reviewed for component radiolucent lines (RLLs) and proximal humeral migration.Aims
Methods
Controversy about the use of an anatomical total shoulder arthroplasty
(aTSA) in young arthritic patients relates to which is the ideal
form of fixation for the glenoid component: cemented or cementless.
This study aimed to evaluate implant survival of aTSA when used
in patients aged < 60 years with primary glenohumeral osteoarthritis (OA),
and to compare the survival of cemented all-polyethylene and cementless
metal-backed glenoid components. A total of 69 consecutive aTSAs were performed in 67 patients
aged < 60 years with primary glenohumeral OA. Their mean age
at the time of surgery was 54 years (35 to 60). Of these aTSAs,
46 were undertaken using a cemented polyethylene component and 23
were undertaken using a cementless metal-backed component. The age, gender,
preoperative function, mobility, premorbid glenoid erosion, and
length of follow-up were comparable in the two groups. The patients
were reviewed clinically and radiographically at a mean of 10.3
years (5 to 12, Aims
Materials and Methods