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Shu B, Ou X, Hu L. Influential articles on shoulder arthroplasty: bibliometric analysis and visualized study. J Shoulder Elbow Surg 2023; 32:677-684. [PMID: 36323365 DOI: 10.1016/j.jse.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/14/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Shoulder arthroplasty has had increasing global demand, technical development, and research interest in the past few decades, with the publication of numerous articles. However, little is known about the characteristics and evaluation of these articles. Our objective was to study and analyze the top 100 cited articles in shoulder arthroplasty research. MATERIALS AND METHODS Publications on shoulder arthroplasty from inception to 2022 were retrieved from the Web of Science. The top 100 publications were defined by the number of citations, and their characteristics were recorded and analyzed. A visualized study of the articles was performed using VOSviewer software. RESULTS The top 100 cited articles were published between 1981 and 2018, with the 2000s the most productive decade. Citations per article ranged from 103 to 822. The countries with the most articles were the United States followed by France and Switzerland. Most of the articles were level III evidence. The keywords for the articles were primarily in 5 clusters: infection, fracture, osteoarthritis, perioperative complications, and prosthetic design. CONCLUSIONS The characteristics of influential articles on shoulder arthroplasty were thoroughly analyzed. Most studies focused on surgical techniques and perioperative complications with a relatively low level of evidence.
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Affiliation(s)
- Boshen Shu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xuehai Ou
- Department of Hand Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Leiming Hu
- Department of Hand Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Abdelmalik BM, Hao KA, Turnbull LM, Wright TW, Wright JO, Farmer KW, Pazik M, King JJ. Survivorship after reverse total shoulder arthroplasty and predictors of 1-year and overall mortality. J Shoulder Elbow Surg 2023; 32:e1-e10. [PMID: 35973517 DOI: 10.1016/j.jse.2022.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient survivorship and risk factors of mortality after reverse total shoulder arthroplasty (RTSA) are seldom and inadequately studied. The purpose of this study was to evaluate the mortality rates and predictors of 1-year and overall mortality after RTSA. METHODS We retrospectively reviewed 1518 consecutive adult patients who underwent RTSA at our institution. The Social Security Death Index and institutional electronic medical records were queried to verify patient living status. Patients were censored at date of death if deceased, the date that living status was verified if alive, or latest follow-up if living status could not be verified. Mortality rates and risk factors of 1-year and overall mortality after RTSA were identified on univariate and multivariate analysis. RESULTS Mean follow-up was 5.1 ± 3.8 years. Thirty-day (0.1%), 90-day (0.7%), and 1-year (1.8%) mortality rates were low but increased to 11% at 5 years. Increased odds of 1-year mortality were independently associated with heart disease (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.07-6.50, P = .035) and use of a cemented stem (OR 2.64, 95% CI 1.04-6.69, P = .041). Independent risk factors of overall mortality included older age at surgery (hazard ratio [HR] 1.05, 95% CI 1.03-1.07, P < .001), minority ethnicity (protective risk factor, HR 0.37, 95% CI 0.15-0.91, P = .031), heart disease (HR 1.42, 95% CI 1.00-2.02, P = .048), diabetes mellitus (HR 1.47, 95% CI 1.04-2.08, P = .028), tobacco use (HR 1.79, 95% CI 1.08-2.98, P = .025), post renal transplant (HR 12.69, 95% CI 3.92-41.05, P < .001), chronic liver failure (HR 4.40, 95% CI 1.38-14.09, P = .013), and receiving a cemented stem (HR 1.60, 95% CI 1.13-2.26, P = .008). CONCLUSIONS RTSA carries a low risk of short-term mortality postoperatively. When counseling patients preoperatively, surgeons should consider the predictors of mortality after RTSA reported herein to ensure appropriate patient selection and counseling.
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Affiliation(s)
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lacie M Turnbull
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Marissa Pazik
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA.
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Marigi EM, Iturregui JM, Werthel JD, Sperling JW, Sanchez-Sotelo J, Schoch BS. Higher rates of mortality and perioperative complications in patients undergoing primary shoulder arthroplasty and a history of previous stroke. J Shoulder Elbow Surg 2022; 32:e216-e226. [PMID: 36375747 DOI: 10.1016/j.jse.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cerebrovascular accidents (CVAs), or strokes, are the second most common cause of mortality and third most common cause of disability worldwide. Although advances in the treatment of strokes have improved survivorship following these events, there remains a limited understanding of the effect of a prior stroke and sequelae on patients undergoing shoulder arthroplasty (SA). This study aimed to determine the outcomes of patients with a history of stroke with sequela undergoing primary SA. METHODS Over a 30-year time period (1990-2020), 205 primary SAs (32 hemiarthroplasties [HAs], 56 anatomic total shoulder arthroplasties [aTSAs], and 117 reverse shoulder arthroplasties [RSAs]) were performed in patients who sustained a previous stroke with sequela and were followed for a minimum of 2 years. This cohort was matched (1:2) according to age, sex, body mass index, implant, and year of surgery with patients who had undergone HA or aTSA for osteoarthritis or RSA for cuff tear arthropathy. Mortality after primary SA was individually calculated through a cumulative incidence analysis. Implant survivorship was analyzed with a competing risk model selecting death as the competing risk. RESULTS The stroke cohort sustained 38 (18.5%) surgical and 42 (20.5%) medical perioperative complications. Compared with the control group, the stroke cohort demonstrated higher rates of any surgical complication (18.5% vs 10.7%; P = .007), instability (6.3 % vs 1.7%; P = .002), venous thromboembolism (3.4% vs 0.5%; P = .004), pulmonary embolus (2.0% vs 0%; P = .005), postoperative stroke (2.4% vs 0%; P = .004), respiratory failure (1.0% vs 0%; P = .045), any medical complication (20.5% vs 7.3%; P < .001), and 90-day readmission (16.6% vs 4.9%; P < .001). Additionally, RSA in the stroke cohort was associated with higher reoperation (8.5% vs 2.6%; P = .011) and revision rates (6.8% vs 1.7%; P = .013) compared with the matched cohort. Subsequent cumulative incidences of death at 1, 2, 5, 10, 15, and 20 years were 4.4% vs 3.4%, 10.7% vs 5.1%, 25.6% vs 14.7%, 51.6% vs 39.3%, 74.3% vs 58.6%, and 92.6% vs 58.6% between the stroke and matched cohorts, respectively (P < .001). CONCLUSIONS A preoperative diagnosis of a stroke in patients undergoing primary SA is associated with higher rates of perioperative complications and mortality when compared to a matched cohort. This information should be considered to counsel patients and surgeons to optimize care and help mitigate risks associated with the perioperative period.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jose M Iturregui
- Department of Orthopedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Jean-David Werthel
- Department of Orthopedic Surgery, Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
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Rondon AJ, Paziuk T, Gutman MJ, Williams GR, Namdari S. Spacers for life: high mortality rate associated with definitive treatment of shoulder periprosthetic infection with permanent antibiotic spacer. J Shoulder Elbow Surg 2021; 30:e732-e740. [PMID: 34087272 DOI: 10.1016/j.jse.2021.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Periprosthetic joint infection following shoulder arthroplasty represents a challenging problem for orthopedic surgeons. Although recent studies have supported 2-stage exchanges, this treatment choice may not be appropriate for all patients. Definitive antibiotic spacer placement represents one treatment strategy with limited reported outcomes in the literature. The purpose of this study was to investigate the mortality rate and functional outcomes associated with definitive spacer placement. METHODS A retrospective chart review identified 17 patients who were treated with definitive antibiotic spacer placement (18 spacers) and were followed up for a minimum of 2 years after surgery. The mortality rate over the study period was determined. Demographic information, clinical course, patient-reported outcomes (American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, and Veterans RAND 12 [VR-12] score), infection parameters as defined by International Consensus Meeting criteria, radiographic evaluation findings, and rotator cuff integrity at the time of spacer placement were collected. RESULTS Seventeen patients underwent treatment with retained antibiotic spacers at a mean age of 62.4 years (range, 50-73 years). Ten patients were women, and the mean body mass index was 30.5 (range, 22.9-39.9). Spacer placement occurred at a mean of 6.1 years (range, 0.48-14.9 years) following index arthroplasty. Five patients required spacer exchange. The most common organisms were Cutibacterium acnes (6) and methicillin-sensitive Staphylococcus aureus (6); in addition, methicillin-resistant S aureus (2), coagulase-negative Staphylococcus (2), Serratia marcescens (1), gram-positive cocci (1), Enterobacter faecalis (1), Enterobacter cloacae (1), diphtheroids (1), and an infection with negative culture findings (1) were observed. The mortality rate was 52.9% (9 of 17 patients). Among the 8 surviving patients, the mean American Shoulder and Elbow Surgeons score was 33.9 (range, 13.3-80.0), the mean Single Assessment Numeric Evaluation score was 35.6 (range, 0.0-80.0), the mean VR-12 mental score was 57.2 (range, 36.6-66.9), and the mean VR-12 physical score was 37.1 (range, 21.7-64.0) at a mean of 4.7 years (range, 2.0-8.8 years). CONCLUSION Definitive antibiotic spacer placement is an acceptable method to treat infection in medically frail patients who have a high mortality risk. Spacer exchange may be necessary because of persistent infection, and functional results are poor.
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Affiliation(s)
| | - Taylor Paziuk
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael J Gutman
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gerald R Williams
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Surena Namdari
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
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Farley KX, Wilson JM, Kumar A, Gottschalk MB, Daly C, Sanchez-Sotelo J, Wagner ER. Prevalence of Shoulder Arthroplasty in the United States and the Increasing Burden of Revision Shoulder Arthroplasty. JB JS Open Access 2021; 6:JBJSOA-D-20-00156. [PMID: 34278185 PMCID: PMC8280071 DOI: 10.2106/jbjs.oa.20.00156] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Existing data on the epidemiology of shoulder arthroplasty are limited to future projections of incidence. However, the prevalence of shoulder arthroplasty (the number of individuals with a shoulder arthroplasty alive at a certain time and its implications for the burden of revision procedures) remains undetermined for the United States. Hence, the purpose of this study was to estimate the prevalence of shoulder arthroplasty in the United States.
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Affiliation(s)
- Kevin X Farley
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | - Jacob M Wilson
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | - Anjali Kumar
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | | | - Charles Daly
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | | | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
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Dacombe P, Harries L, McCann P, Crowther M, Packham I, Sarangi P, Whitehouse MR. Predictors of mortality following shoulder arthroplasty. J Orthop 2020; 22:179-183. [PMID: 32419761 DOI: 10.1016/j.jor.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction This study aims to determine 30-day, 90-day and 1 year mortality following shoulder arthroplasty and identify predictors of mortality. Materials and methods All shoulder arthroplasty cases performed at the host institution, between 2012 and 2018 were included. A review of patient records was completed to identify demographic data, Charlson comorbidity index, date of death and factors associated with mortality.Mortality analysis was undertaken using 1-Kaplan Meier estimates with 95% confidence intervals. Comparative analysis was performed for mortality following shoulder arthroplasty for elective vs. trauma and for primary vs. revision surgery. A multiple regression analysis was conducted to determine which factors were associated with increased mortality risk. Results 640 shoulder arthroplasty cases were performed in 566 patients. There were 44 deaths, 1 occurred within 90 days and 13 within 1 year. Trauma procedures had a hazard ratio of 5.3 (95% CI 1.9 to 15.0) for mortality compared to elective procedures (5 year survival trauma 78.6% (95% CI 60.7 to 89.0); elective 91.8% (95% CI 88.1 to 94.4). 1-year mortality was predicted by presence of malignancy, liver failure, cardiac failure, peptic ulcer, trauma surgery, revision surgery, intra-operative complication, transfusion and increased length of stay. Discussion 30-day, 90-day and 1-year mortality following shoulder arthroplasty were 0%, 0.16% and 2%; trauma procedures had a hazard ratio of 5.3 for 1-year mortality when compared to elective surgery. Malignancy, cardiac failure, liver failure, peptic ulcer and trauma surgery are associated with an increased risk of 1-year mortality.
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Affiliation(s)
- P Dacombe
- Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - L Harries
- Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - P McCann
- Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK.,Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - M Crowther
- Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - I Packham
- Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - P Sarangi
- Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK
| | - M R Whitehouse
- Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristo, UK
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Fernández-Cortiñas AB, Vidal Campos J, Marco Martínez F. Proximal humeral fracture in patients with high Charlson comorbidity index: mortality rate according to treatment choice. Musculoskelet Surg 2020; 105:167-172. [PMID: 32008184 DOI: 10.1007/s12306-020-00642-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the relevance of a commonly used morbidity prognostic tool, the Charlson comorbidity index (CCI), in determining the survival rate of patients with isolated proximal humeral fractures (PHFs) and to determine the impact of surgical treatment according to previous comorbidities (measured with CCI). MATERIALS AND METHODS All patients who were treated for a single PHF in our institution for 29 consecutive months were included in this retrospective study, with a minimum follow-up of 24 months (mean 52.8 months). Two groups were established according to the type of treatment received (surgical versus non-surgical). Preinjury comorbidities were identified, and the age-adapted CCI was calculated. All complications and mortality rates were prospectively recorded over the complete follow-up period. RESULTS Patients with elevated preinjury comorbidities (CCI > 5) demonstrated a significant increase in mortality (HR = 4.64) compared to those with CCI ≤ 5. In addition, patients with high comorbidities (CCI > 5) who underwent surgical treatment demonstrated a statistically significant increase in mortality (HR = 6.92) compared to patients with similarly high comorbidities (CCI > 5) who underwent non-surgical treatment. CONCLUSIONS Patients with high preinjury comorbidities (CCI > 5) experienced an increased mortality risk if they underwent surgical treatment for isolated PHFs. The use of a morbidity prognostic tool, such as the CCI, can help predict the outcome (particularly mortality) in these patients and may aid in making decisions in terms of operative versus non-operative treatment to minimize patient mortality. LEVEL OF EVIDENCE Level III; Retrospective Comparative Study; Treatment Study.
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Affiliation(s)
- Ana Belén Fernández-Cortiñas
- Complutense University of Madrid, Madrid, Spain. .,Department of Orthopaedic Surgery, Cosaga Hospital, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
| | - Jesús Vidal Campos
- Department of Orthopaedic Surgery, El Carmen Hospital, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Fernando Marco Martínez
- Complutense University of Madrid, Madrid, Spain.,Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University, Madrid, Spain
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Mortality after shoulder arthroplasty: 30-day, 90-day, and 1-year mortality after shoulder replacement--5853 primary operations reported to the Danish Shoulder Arthroplasty Registry. J Shoulder Elbow Surg 2016; 25:756-62. [PMID: 26704362 DOI: 10.1016/j.jse.2015.09.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/24/2015] [Accepted: 09/29/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The primary aim was to quantify the 30-day, 90-day, and 1-year mortality rates after primary shoulder replacement. The secondary aims were to assess the association between mortality and diagnoses and to compare the mortality rate with that of the general population. METHODS The study included 5853 primary operations reported to the Danish Shoulder Arthroplasty Registry between 2006 and 2012. Information about deaths was obtained from the Danish Cause of Death Register and the Danish Civil Registration System. Age- and sex-adjusted control groups were retrieved from Statistics Denmark. RESULTS The mean age was 69.3 ± 11.6 years, and 69.2% of patients were women. Of the patients, 39 (0.7%) died within 30 days, 88 (1.5%) within 90 days, and 222 (3.8%) within 1 year. Fracture patients had an incidence rate of 1256 per 100,000 within 30 days, which was significantly higher than the incidence rate of 182 per 100,000 in the general population (P < .001), whereas osteoarthritis patients had an incidence of 111 per 100,000, which was significantly lower than the incidence rate of 125 per 100,000 in the general population. CONCLUSIONS Fracture patients had a 6 times higher incidence of death within 30 days than the general population. However, the difference was equalized during the first year. This finding indicates that the injury and arthroplasty procedure are associated with an increased risk of death for these patients. Pulmonary, cardiac, and abdominal causes of death were common, and for fracture patients in particular, close postoperative monitoring of pulmonary, cardiac, and abdominal conditions seems important.
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