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Offset in Reverse Shoulder Arthroplasty: Where, When, and How Much
Wright, Melissa A.; Murthi, Anand M.
doi : 10.5435/JAAOS-D-20-00671
Journal of the American Academy of Orthopaedic Surgeons. 29(3):89-99, February 1, 2021.
Since the advent of Paul Grammont medialized reverse shoulder prosthesis in the 1980s, shoulder surgeons have had a reliable option for treating glenohumeral joint disease in the rotator cuff–deficient shoulder. However, the prosthesis is not without complications, including scapular notching, instability, and limited rotational motion. Implants have been modified from the original design in an effort to reduce the risk of these complications. Increasing the offset, or lateralization, of the glenosphere may reduce the rate of scapular notching, reduce impingement, increase stability, and improve rotational motion. However, a more lateralized glenosphere could lead to baseplate loosening, decreased deltoid efficiency, and increased risk of acromial fracture. Increasing the offset on the humeral side, rather than the glenosphere side, may be able to reduce the rate of scapular notching and improve rotational motion without an increased risk of baseplate loosening. Humeral lateralization also improves tension of the rotator cuff and maintains good deltoid efficiency. However, humeral lateralization provides little stability benefit, and acromial fracture remains a risk. Ultimately, the surgeon must be familiar with the implants he or she is using and the options for both glenosphere and humeral lateralization to ensure that risks and benefits can be weighed for each patient.
Diagnosis and Management of Subcoracoid Impingement
McKernan, Michael J.; Schickendantz, Mark S.; Frangiamore, Salvatore J.
doi : 10.5435/JAAOS-D-20-00008
Journal of the American Academy of Orthopaedic Surgeons. 29(3):100-107, February 1, 2021.
Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. Because of its relative rarity in isolation and nonspecific presentation, diagnosis and management are often challenging for orthopaedic surgeons and their patients. Stenosis of the subcoracoid space between the lesser tuberosity and the coracoid process <6 mm can lead to anterior shoulder pain and associated rotator cuff and biceps pathology. Multiple imaging modalities are available to assess narrowing of the coracohumeral interval, each with its strengths and limitations. If the patient can be accurately diagnosed with subcoracoid impingement, both conservative and surgical management options are available. Despite earlier case series demonstrating promising results with arthroscopic treatment, comparative studies have yet to support these initial claims.
The Quadrilateral Plate in Acetabular Fracture Surgery: What Is It and When Should It Be Addressed?
Butler, Bennet A.; Stover, Michael D.; Sims, Stephen H.
doi : 10.5435/JAAOS-D-20-00080
Journal of the American Academy of Orthopaedic Surgeons. 29(3):e109-e115, February 1, 2021.
The quadrilateral plate (QP) is the relatively flat surface of bone in the true pelvis lying directly medial to the acetabulum. This surface is frequently involved in acetabular fractures. Elderly individuals, in particular, commonly sustain anterior column fractures with incomplete or complete posterior hemitransverse fracture lines with associated QP comminution. If QP fracture lines propagate through the superior weight-bearing surface of the acetabulum, the femoral head may displace medially, leading to poor outcomes if not addressed. Fortunately, the collective work of many orthopaedic surgeons has resulted in numerous effective methods for approaching, reducing, and stabilizing the QP and the diverse family of fractures which affect it. A thorough understanding of the QP, its anatomy, radiology, and techniques for fixation, is required to optimize patient outcomes.
Management of Metastatic Disease of the Upper Extremity
Voskuil, Ryan T.; Mayerson, Joel L.; Scharschmidt, Thomas J.
doi : 10.5435/JAAOS-D-20-00819
Journal of the American Academy of Orthopaedic Surgeons. 29(3):e116-e125, February 1, 2021.
Metastatic disease is the most common pathologic cause of bone destruction, and the upper extremity is frequently involved. This location presents many surgical challenges, but there have been several recent implant and technique-related advances that have improved outcomes. Patients can be treated nonsurgically, with radiation or with surgery, depending on patient characteristics, signs/symptoms, primary diagnosis, location, and extent of bone destruction. Most locations in the upper extremity besides the humerus can be treated nonsurgically or with radiation. This is also true of the humerus, but when surgery is indicated, plate fixation is acceptable when adequate proximal and distal cortical bone is present for screw purchase. Intramedullary nailing is used frequently in metastatic humeral disease as well, especially in the diaphysis. When extensive destruction or disease progression precludes internal fixation, a resection with endoprosthetic reconstruction can be considered. Oncologic hemiarthroplasty endoprosthetics still have a role, but reverse shoulder designs are beginning to show improved function. Humeral prosthesis designs are continuing to improve, and are becoming more modular, with custom implants still playing a role in certain challenging scenarios.
Case Studies AAOS Clinical Practice Guideline: Management of Rotator Cuff Injuries
Weber, Stephen; Chahal, Jaskarndip
doi : 10.5435/JAAOS-D-20-00450
Journal of the American Academy of Orthopaedic Surgeons. 29(3):e104-e108, February 1, 2021.
Shoulder disease is a major cause of musculoskeletal disability in the United States. Chronic shoulder pain has been estimated to affect approximately 8% of all American adults, second only to chronic knee pain in our society's burden of musculoskeletal disease. Rotator cuff pathology is the leading cause of shoulder-related disability seen by orthopaedic surgeons, and surgical volume is on the rise. One study, for example, notes a 141% increase in rotator cuff repairs from 1996 to 2006 in the United States. Because rotator cuff disease is such a common condition with evidence of various strength supporting different common treatments, the American Academy of Orthopaedic Surgeons published a clinical practice guideline to help elucidate best practices for its treatment. A summary of these guidelines with the strength of the recommendations is available at OrthoGuidelines (http://www.orthoguidelines.org/topic?id=1027) with links to rationale behind each of the conclusions. This study will illustrate the use of these guidelines through presentation and discussion of hypothetical clinical cases.
Patient Outcomes After Transolecranon Fracture-Dislocation
Haller, Justin M.; Hulet, D. Andrew; Hannay, William; Cardon, Jeffrey; Tashjian, Robert; Beingessner, Daphne
doi : 10.5435/JAAOS-D-20-00254
Journal of the American Academy of Orthopaedic Surgeons. 29(3):109-115, February 1, 2021.
There are few small case series that discuss patient outcomes after a transolecranon fracture-dislocation, and they suggest that patients have reasonable function after injury. The purpose of this study was to describe the injury pattern and clinical outcomes of transolecranon fracture-dislocations.
Complications and Readmissions After Reverse and Anatomic Total Shoulder Arthroplasty With Same-day Discharge
Antonacci, Christopher L.; Cu, Benedict J.; Erickson, Brandon J.; Vazquez, Oscar; Alberta, Frank G
doi : 10.5435/JAAOS-D-20-00245
Journal of the American Academy of Orthopaedic Surgeons. 29(3):116-122, February 1, 2021.
Recent studies have demonstrated the safety of anatomic total shoulder arthroplasty (TSA) in an outpatient setting. No clinical studies, to date, have specifically analyzed complication and readmission rates after reverse total shoulder arthroplasty (RTSA) with same-day discharge. The purpose of this study was to compare the 90-day complication and readmission rates of patients undergoing TSA and RTSA with same-day discharge.
Social Media Utilization Among Shoulder and Elbow Surgeons
Narain, Ankur S.; Dhayalan, Arjun; Weinberg, Maxwell; Latario, Luke D.; Shuman, Matthew E.; Bango, Jugert; Holmes, Sara; Patel, Jay K.; Chan, Wayne; Aaron, Daniel L
doi : 10.5435/JAAOS-D-20-00085
Journal of the American Academy of Orthopaedic Surgeons. 29(3):123-130, February 1, 2021.
Social media represents a novel platform for patient-physician interaction. Although social media utilization patterns have been analyzed in other fields, no such study has been performed in shoulder and elbow specialists.
Investigating the International Normalized Ratio Thresholds for Complication in Shoulder Arthroplasty
Sivasundaram, Lakshmanan; Raji, Yazdan; Mengers, Sunita R. P.; Trivedi, Nikunj N.; Du, Jerry; Karns, Michael R.; Voos, James E.; Lee, Adrienne; Gillespie, Robert J
doi : 10.5435/JAAOS-D-20-00280
Journal of the American Academy of Orthopaedic Surgeons. 29(3):131-137, February 1, 2021.
In patients on warfarin anticoagulation therapy, elective shoulder arthroplasty surgeons must carefully balance bleeding and embolic risks. Currently, an international normalized ratio (INR) threshold of 1.5 is supported in the setting of elective surgery. However, no previous study has investigated the optimal preoperative INR target specifically in shoulder arthroplasty. The purpose of this study was to evaluate the association of preoperative INR with rates of transfusion, complication, and readmission/revision surgery in shoulder arthroplasty.
Patient Attitudes and Preferences for Orthopaedic Surgeon Greetings
Golz, Andrew; Kim, Andrew; Murphy, Michael; Salazar, Dane
doi : 10.5435/JAAOS-D-20-00230
Journal of the American Academy of Orthopaedic Surgeons. 29(3):e126-e131, February 1, 2021.
Numerous studies have demonstrated that patient-centered interaction promotes higher satisfaction and improved health outcomes, whereas poor communication behaviors have been associated with decreased satisfaction and an increased risk of malpractice claims. To our knowledge, no such study has investigated patient preferences for greetings and handshakes in the outpatient orthopaedic setting.
Underweight Patients Are the Greatest Risk Body Mass Index Group for 30-Day Perioperative Adverse Events After Total Shoulder Arthroplasty
Ottesen, Taylor D.; Hsiang, Walter R.; Malpani, Rohil; Nicholson, Allen D.; Varthi, Arya G.; Rubin, Lee E.; Grauer, Jonathan N
doi : 10.5435/JAAOS-D-20-00049
Journal of the American Academy of Orthopaedic Surgeons. 29(3):e132-e142, February 1, 2021.
Existing literature investigating the correlation of body mass index (BMI) with surgical complications has focused on those with elevated BMI. These investigations have reported mixed conclusions, possible because of insufficient power, poor controlling of confounding variables, and inconsistent definitions of BMI categories (eg, underweight, overweight, and varying classifications of obese). Few studies have considered complications of patients with low BMI. The aim of the current study was to analyze the spectrum of categories for BMI with 30-day perioperative adverse events after primary total shoulder arthroplasty (TSA) to better assess where along the BMI spectrum patients are at risk for complications.
A Geographic Population-level Analysis of Access to Total Shoulder Arthroplasty in the State of Texas
Gregory, James M.; Wayne, Colton D.; Miller, Adam J.; Kozemchak, Adam M.; Bailey, Lane; Warth, Ryan J
doi : 10.5435/JAAOS-D-20-00035
Journal of the American Academy of Orthopaedic Surgeons. 29(3):e143-e153, February 1, 2021.
Managing costs and improving access to care are two important goals of healthcare policy. The purposes of this study were to (1) evaluate the changes in distribution of total shoulder arthroplasty (TSA) cases in the state of Texas from 2010 to 2015 and (2) to evaluate patient access to TSA surgery centers as measured by driving miles.
