Faculty Bibliography

BACKGROUND/UNASSIGNED:Massive irreparable rotator cuff tears (MIRCTs) remain a challenging treatment paradigm, particularly for nonelderly patients without pseudoparalysis or arthritis. PURPOSE/UNASSIGNED:To use a network meta-analysis to analyze comparative studies of surgical treatment options for MIRCTs in patients <70 years of age for several patient-reported outcomes, range of motion (ROM), and acromiohumeral distance (AHD). STUDY DESIGN/UNASSIGNED:Network meta-analysis of comparative studies; Level of evidence, 3. METHODS/UNASSIGNED:package Version 0.9-6 in R. RESULTS/UNASSIGNED:= .024). CONCLUSION/UNASSIGNED:For patients <70 years with MIRCT without significant arthritis or pseudoparalysis, it appears that graft interposition repair techniques, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains, while RSA provides the least benefit in forward flexion.

BACKGROUND:The Walch classification is commonly used by surgeons when determining the treatment of osteoarthritis (OA). However, its utility in prognosticating patient clinical state before and after TSA remains unproven. We assessed the prognostic value of the modified Walch glenoid classification on preoperative clinical state and postoperative clinical and radiographic outcomes in total shoulder arthroplasty (TSA). METHODS:A prospectively collected, multicenter database for a single-platform TSA system was queried for patients with rotator cuff-intact OA and minimum 2 year follow-up after anatomic (aTSA) and reverse TSA (rTSA). Differences in patient-reported outcome scores (Simple Shoulder Test, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Shoulder Pain and Disability Index, visual analog scale for pain, Shoulder Function score), combined patient-reported and clinical-input scores (Constant, University of California-Los Angeles shoulder score, Shoulder Arthroplasty Smart Score), active range of motion values (forward elevation [FE], abduction, external rotation [ER], internal rotation [IR], and radiographic outcomes (humeral and glenoid radiolucency line rates, scapula notching rate) were stratified and compared by glenoid deformity type per the Walch classification for aTSA and rTSA cohorts. Comparisons were performed to assess the ability of the Walch classification to predict the preoperative, postoperative, and improved state after TSA. RESULTS:1008 TSAs were analyzed including 576 aTSA and 432 rTSA. Comparison of outcomes between Walch glenoid types resulted in 15 pairwise comparisons of 12 clinical outcome metrics, yielding 180 total Walch glenoid pairwise comparisons for each clinical state (preoperative, postoperative, improvement). Of the 180 possible pairwise Walch glenoid type and metric comparisons studied for aTSA and rTSA cohorts, <6% and <2% significantly differed in aTSA and rTSA cohorts, respectively. Significant differences based on Walch type were seen after adjustment for multiple pairwise comparisons in the aTSA cohort for FE and ER preoperatively, the Constant score postoperatively, and for abduction, FE, ER, Constant score, and SAS score for pre- to postoperative improvement. In the rTSA cohort, significant differences were only seen in abduction and Constant score both postoperatively and for pre- to postoperative improvement. There were no statistically significant differences in humeral lucency rate, glenoid lucency rate (aTSA), scapular notching rate (rTSA), complication rates, or revision rates between Walch glenoid types after TSA. CONCLUSION/CONCLUSIONS:Although useful for describing degenerative changes to the glenohumeral joint, we demonstrate a weak association between preoperative glenoid morphology according to the Walch classification and clinical state when evaluating patients undergoing TSA for rotator cuff-intact OA. Alternative glenoid classification systems or predictive models should be considered to provide more precise prognoses for patients undergoing TSA for rotator cuff-intact OA.

➤ Aging is associated with well-documented neurocognitive and psychomotor changes.➤ These changes can be expected to impact the skill with which orthopaedic surgeons continue to perform surgical procedures.➤ Currently, there is no standardized approach for assessing the changes in surgical skills and clinical judgment that may occur with aging.➤ Oversight by the U.S. Equal Employment Opportunity Commission, the impact of the Age Discrimination in Employment Act, and the current legal climate make it difficult to institute a mandatory assessment program.➤ The regularly scheduled credentialing process that occurs at each institution can be the most effective time to assess for these changes because it utilizes an established process that occurs at regularly scheduled intervals.➤ Each department of orthopaedic surgery and institution should determine an approach that can be utilized when there is concern that a surgeon's surgical skills have shown signs of deterioration.

BACKGROUND:The incidence of proximal humerus fractures (PHF) is continuing to rise due to shifts towards a more aged population as well as advancements in surgical treatment options. The purpose of this study is to examine and compare trends in the treatment of PHFs (nonoperative vs. operative; different surgical treatments) across different age groups over the last decade (2010-2020). METHODS:The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried using International Classification of Diseases and Current Procedural Terminology codes to identify all patients presenting with or undergoing surgery for PHF between 2010 and 2020. Treatment trends, demographics, and insurance information were analyzed during the study period. Comparisons were made between operative and nonoperative trends with respect to the number and type of surgeries performed among 3 age groups: ≤49 years, 50-64 years, and ≥65 years. The rate of postoperative complications and reoperations was evaluated and compared among different surgical treatments for patients with a minimum 1-year postoperative follow-up. RESULTS: = 0.112, P = .730). CONCLUSION/CONCLUSIONS:Nonsurgical treatment remains the mainstay treatment of PHFs. Although there is no increase in the prevalence of operative treatment in patients ≥50 years in the last decade, there is an exponential increase in the use of rTSA with a corresponding decrease in HA and IF, a trend more substantial in patients ≥65 years compared with patients between 50 and 64 years.

BACKGROUND/UNASSIGNED:The aim of this study is to investigate the pattern of changes in activities of daily living (ADLs), sleep disturbance, and pain in the early postoperative period following a total shoulder arthroplasty (TSA). METHODS/UNASSIGNED:Prospective data on patterns of limitation in ADLs, sleep disturbance, and pain were collected from patients undergoing elective TSA preoperatively and at specific time points postoperatively (2, 6, and 12 weeks). At each time point, patients were asked regarding the major limitation affecting their shoulder. Limitations in ADLs and sleep disturbances were scored on a 3-point scale (0 = unable to do, 3 = no difficulty) modeled after the ADL which require active external rotation score and visual analog scale scores were used for pain. Patient responses were analyzed with respect to patient factors (demographics, arm dominance, function of opposite arm, and ambulation status), and living situation (alone, or with caregiver). RESULTS/UNASSIGNED:Shoulder pain (43%) and inability to perform ADLs (38%) were the 2 most commonly reported limitations prior to undergoing TSA. Patients noticed progressive improvements in pain with 37% reductions in visual analog scale scores at 2 weeks and 67% reduction at 3 months. At 2 weeks after TSA, sleep disturbances were the most disabling issue in 33% of the cohort, with considerable improvements (104%) in sleep scores at 3 months compared to pre-op. The ADLs involving forward elevation and working at the waist level improved considerably between 6 weeks and 3 months, but activities involving rotation including reaching behind the back, across the chest, and use of strength showed mild improvements by 3 months. CONCLUSION/UNASSIGNED:This prospective study demonstrates the chronology of improvements in pattern of limitations experienced by patients with respect to pain, sleep, and ADLs in the early postoperative period after TSA. Majority of patients can expect to have 2/3 resolution of pain, improved sleep, and improvement in ADLs involving forward elevation and waist level function by 3 months.