Faculty Bibliography

BACKGROUND/UNASSIGNED:Few studies have directly compared limitations in activities of daily living (ADLs) between reverse shoulder arthroplasty (RSA) and anatomic total shoulder arthroplasty (aTSA). This study evaluates ADL function at mid-term follow-up in patients with revision-free RSA and aTSA. METHODS/UNASSIGNED:This retrospective cohort study included 250 patients who underwent primary aTSA (n = 177) or RSA (n = 73) with a minimum follow-up of 7 years (mean 10 ± 2 years). Patients who had revision surgery were excluded. Multivariable ordinal logistic regression analysis was used to assess the odds of RSA patients reporting better ADL function compared to aTSA patients. RESULTS/UNASSIGNED:Postoperatively, a greater proportion of aTSA patients reported normal ADLs compared to RSA patients. On multivariable analysis, controlling for baseline differences, RSA patients reported lower ADL function for personal hygiene/toilet needs (Odds ratio [OR] 0.21 [95% CI: 0.07-0.65]; p = 0.006), washing/combing hair (OR 0.36 [0.13-1.02]; p = 0.049), putting on a button-up shirt (OR 0.08 [0.02-0.25]; p < 0.001), and putting on pants (OR 0.12 [0.03-0.39]; p < 0.001). DISCUSSION/UNASSIGNED:After adjusting for differences in baseline factors, RSA patients reported greater difficulty with specific ADL tasks-including toileting, personal hygiene, grooming, and dressing-compared to aTSA patients. LEVEL OF EVIDENCE/UNASSIGNED:Level III; Retrospective cohort study.

PURPOSE/OBJECTIVE:The purpose of this study was to evaluate the effect that associated glenohumeral dislocations have on outcomes following surgical treatment of proximal humerus fractures. METHODS:This IRB-approved study reports on 301 patients, who underwent operative treatment for proximal humerus fractures at an academic medical center from January 2006 to January 2023. Fractures were classified according to the Neer system. Patients were separated into two cohorts based on whether a glenohumeral dislocation was present at the time of initial injury. Outcomes measured included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, shoulder range of motion (forward elevation, external rotation, internal rotation), readmission rates, complications, hardware removal, and need for revision surgery. Independent samples t-tests and chi-squared analysis were used for continuous and categorical variables, respectively. A binary logistic regression was performed to analyze the influence of these factors on complication rate. RESULTS:230 patients sustained an isolated fracture (PHF) and 71 sustained a fracture-dislocation (FD). Significant differences were observed between the FD and PHF groups in all measured outcomes. The FD group had a poorer DASH score (24.38 ± 19.09 vs 10.54 ± 13.67; P < 0.001) and reduced range of shoulder motion in forward elevation (114° ± 40° vs 162° ± 19°; P < 0.001), external rotation (40° ± 19° vs 66° ± 19°; P < 0.001), and internal rotation (57° ± 26° vs 82° ± 21°; P < 0.001). Readmission rates were higher in the FD group (0.28 ± 0.85 vs 0.05 ± 0.28; P < 0.001). The FD cohort also had a higher rate of complications (25.35% vs 6.52%; P < 0.001), need for removal of hardware (14.08% vs 3.04%; P = 0.002), and overall revision surgery (11.27% vs 1.30%; P < 0.001). The FD cohort demonstrated a greater incidence of AVN (12.68% vs 4.35%; P = 0.012). No significant difference was observed regarding rates of fracture healing and recurrent dislocation. Multivariate analysis in the form of binary logistic regression indicated that fracture-dislocation significantly increased the complication risk (OR = 3.310, 95% CI = 1.42-7.70; P = 0.005). CONCLUSION/CONCLUSIONS:Proximal humerus fracture-dislocations are associated with worse functional outcomes and higher complication rates compared to those without dislocations. These findings highlight the potential need for specialized treatment strategies to mitigate the impact of dislocation on recovery.

An essential goal of the care that orthopaedic surgeons provide is improving outcomes in orthopaedic surgery. The use of nutritional interventions to improve outcomes has not been previously emphasized. It is important to focus on the types of nutritional interventions available and how they have been shown to affect the outcomes of treatment of fractures and elective procedures, including anterior cruciate ligament reconstruction and joint arthroplasty, with an emphasis on total shoulder arthroplasty.

Parkinson disease (PD) is the second most common neurodegenerative disorder in the United States. Despite its rapid increase in prevalence over recent years, there remains a paucity of literature examining the optimal orthopedic management of populations affected by PD and the risk of complications. In this review, we provide insight into the pathophysiology, etiology, manifestations, and orthopedic management of PD, with an emphasis on adult reconstruction. Although limited outcome studies suggest that joint replacement may consistently offer improvement in pain, there is an increased risk of complications and reoperation, with significant functional improvement often being unpredictable.

The landscape of total shoulder arthroplasty (TSA) is rapidly evolving, with a significant shift toward outpatient procedures. This transition has been supported by enhanced recovery protocols and shorter hospital stays. Key factors for successful outpatient TSA include careful patient selection, focusing on individuals with minimal comorbidities, and preoperative optimization, such as patient education and mental health assessments. Intraoperative considerations like blood loss management, pain control, and surgical efficiency play a crucial role in ensuring positive outcomes. Although challenges remain, including patient selection bias and the need for standardized protocols, ongoing research, innovation in surgical practices, and integration of technology can further enhance the safety and effectiveness of outpatient TSA. Ultimately, with appropriate patient selection and optimization strategies, outpatient TSA can provide comparable outcomes to inpatient procedures, benefiting both patients and health care systems.

BACKGROUND:Pre-osteoarthritic posterior subluxation of the humeral head (PPSHH), also referred to as a Walch B0 glenoid, is characterized by pathologic posterior subluxation of the humeral head without degenerative bony changes on plain radiographs. The purpose of this study was to describe the imaging findings of PPSHH and to assess the relationship between glenoid retroversion and HH subluxation. METHODS:This was a retrospective case series of patients with symptomatic PPSHH. Retroversion was measured on magnetic resonance imaging based on both Friedman's line and the scapular axis line. HH subluxation was measured based on the glenohumeral index (GHI) and the scapulohumeral index (SHI). The relationship between retroversion and HH subluxation was evaluated. The difference in glenoid cartilage thickness between the anterior and posterior aspects of the glenoid was compared. RESULTS:Eight patients were included (mean age, 34.0±4.7 years). Mean retroversion was 17.2°±5.8° based on Friedman's line and 14.0°±5.6° based on scapular axis line. Mean HH subluxation was 63.7%±6.2% based on GHI and 77.5%±9.9% based on SHI. Cartilage thickness was less in the posterior glenoid compared to anterior glenoid, and all patients had selective chondral wear on the posterior glenoid with a posterior labral tear. There was a direct relationship between the degree of glenoid retroversion and HH subluxation. CONCLUSIONS:PPSHH is characterized by posterior glenoid chondral thinning and posterior labral tears in the setting of HH subluxation without erosive osseous changes. This pathology can present with varying degrees of retroversion and HH subluxation, and increasing retroversion is associated with more severe subluxation. Level of evidence: IV.

BACKGROUND/UNASSIGNED:The aim of this study was to evaluate the association between Area Deprivation Index (ADI) and patient outcomes following reverse total shoulder arthroplasty (rTSA). METHODS/UNASSIGNED:A retrospective analysis of patients who underwent an rTSA at a single institution between 2011 and 2021 with minimum 2-year follow-up. Each patient's home address was mapped to the ADI to determine the level of socioeconomic disadvantage. Patients were categorized into 5 groups based on socioeconomic status (SES): ADI group 1; the least deprived group and ADI group 5; the most deprived group. Bivariate analysis was performed to determine the association between the level of SES and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) score. Multivariable regression analysis was utilized to assess the role of independent variables in achieving minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for ASES. RESULTS/UNASSIGNED:= .047). ADI group 1 had the highest postoperative ASES score of 78.6 ± 21.6 compared to 70.0 ± 24.1 in group 5. There was no difference in change preoperative to postoperative ASES scores across ADI subgroups with an average delta ASES score of 42.8 ± 26.2. Like preoperative ROM, there was no difference across ADI subgroups in terms of postoperative ROM. The average percentage of the cohort of patients across ADI subgroups that achieved MCID, SCB, and PASS for ASES was 87.6%, 68.9%, and 57.5%, respectively. There was no difference in terms of achieving MCID, SCB, or PASS for ASES across ADI subgroups. CONCLUSION/UNASSIGNED:The current study supports an inverse relationship between ADI and postoperative outcomes in patients undergoing rTSA. Additionally, our study found that a patient's ability to achieve MCID, SCB, or PASS for ASES at a minimum of 2 years after rTSA was not dependent on SES. Lastly, our study demonstrated that the risk of suffering an adverse event or undergoing a revision surgery were not associated with SES.

BACKGROUND/UNASSIGNED:Patients with anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) can have different short-term rate of improvement (ROI) and different long-term rate of decline (ROD) in range of motion (ROM). This study aims to quantify and compare these rates and identify risk factors associated with a slow ROI and a fast ROD after both aTSA and rTSA. METHODS/UNASSIGNED:This 8-year minimum longitudinal outcome study compares active ROM in 1272 primary aTSA (n = 688) and rTSA (n = 584) patients across 8357 visits and identified patient cohorts with a slow, average, and fast ROI from 0-2 years after surgery and a slow, average, and fast ROD 8 years after surgery relative to peak improvement achieved 2-3 years after surgery. A multivariate regression analysis was performed to identify patient, implant/operative, or postoperative risk factors associated with a slow ROI and fast ROD after both aTSA and rTSA. RESULTS/UNASSIGNED:The results of this 1272 patient long-term clinical outcome study demonstrates that aTSA and rTSA patients with a slow ROI were associated with high preoperative ROM and patients with a fast ROI were associated with low preoperative ROM. aTSA and rTSA patients with high preoperative ROM experienced declines in ROM during the first 3 months, but later recovered at a similar rate and achieved similar peak improvements. aTSA patients with a slow ROI had significantly higher preoperative abduction, internal rotation score, and external rotation, whereas rTSA patients with a slow ROI were significantly more likely to have diabetes, injections, and significantly higher preoperative abduction and internal rotation score. aTSA patients with a fast ROD were significantly more likely to have heart disease and glenoid radiolucent lines, whereas rTSA patients with a fast ROD were significantly more likely to have comorbidities and experience revision surgery. DISCUSSION/UNASSIGNED:The rate of improvement in ROM during the short-term recovery period after aTSA and rTSA is highly dependent on preoperative ROM, whereas the rate of decline in ROM at long-term follow-up is generally impacted by systemic health issues (ie, heart disease and more comorbidities), compromised implant fixation (ie, radiolucent lines after aTSA), and the onset of revision surgery. These findings may be beneficial for patient counseling and expectation management, especially to encourage patients who may have experienced a decline in ROM during the first 3 months after surgery.

BACKGROUND/UNASSIGNED:Liposomal bupivacaine (LB) was developed to provide longer lasting postoperative analgesia, but its clinical role is still being elucidated. We assessed the opioid-sparing effect of LB in patients undergoing total shoulder arthroplasty (TSA) with an interscalene block (ISB). METHODS/UNASSIGNED:Patients scheduled for TSA were randomized to receive either 20 mL of bupivacaine 5 mg/mL control or 10 ml of bupivacaine 5 mg/mL plus LB 133 mg experimental [EXP] for an ISB. The primary outcome was opioid consumption from 24 to 72 hours. The secondary outcomes were cumulative opioid consumption on postoperative days (PODs) 7, 14, and 30 and pain intensity scores measured by the Patient Reported Outcomes Measurement Information System scale. RESULTS/UNASSIGNED:< .05). CONCLUSION/UNASSIGNED:The addition of LB to plain bupivacaine for an ISB is associated with a statistically significant but not clinically meaningful reduction in opioid consumption over the first 72 hours following TSA. These findings should be considered when making an economical decision to use LB.

BACKGROUND/UNASSIGNED:In the past 20 years, the incidence of total shoulder arthroplasty (TSA) has increased greatly, and it is expected to continue growing. Current literature lacks future projections for the utilization of TSA. These projections can help predict demand quantities and anticipate the future burden on the healthcare system. The aim of this study is to determine the predictions of utilization for TSA, primary and revision, through 2060. METHODS/UNASSIGNED:This analysis used the publicly available 2000-2019 data from the Center for Medicare and Medicaid Services Medicare Part-B National Summary. Procedure volumes, including TSA and revision TSA, were determined using Current Procedural Terminology codes and were uplifted to account for the growing number of Medicare eligible patients covered under Medicare Advantage. Log-linear, Poisson, negative binomial regression, and autoregressive integrated moving average models were applied to the procedural volumes to generate projections from 2020-2060. The Poisson model was chosen to display the data based on error analysis and prior literature. RESULTS/UNASSIGNED:The projected annual growth from 2020 to 2060 rates for primary and revision TSA are 11.65% growth (95% confidence interval 11.60%-11.69%) and 13.89% growth (95% confidence interval 13.35%-14.42%), respectively. By 2060, the demand for primary TSA and revision TSA is projected to be 10,029,260 and 1,690,634, respectively. CONCLUSION/UNASSIGNED:The results of this study concluded that both primary and revision TSA procedures are projected to exponentially increase from 2020 to 2060. Additionally, revision procedures are projected to increase at greater rates than their respective primary counterparts.