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Alex Albright J, Testa EJ, Chang K, Scott Paxton E, Daniels AH. Implant-related and medical complications in patients with sarcopenia undergoing total shoulder arthroplasty: A retrospective matched-cohort analysis. Shoulder Elbow 2024; 16:294-302. [PMID: 38818101 PMCID: PMC11135192 DOI: 10.1177/17585732231169500] [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: 12/19/2022] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 06/01/2024]
Abstract
Background In the continually aging United States population, the number of patients with sarcopenia who undergo shoulder arthroplasty may concomitantly increase. This retrospective cohort study aims to evaluate the rates of short-term implant-related and medical complications following shoulder arthroplasty in patients with and without a recent diagnosis of sarcopenia. Methods An exact 1:3 matched analysis of 4177 patients was performed using the PearlDiver database. Multivariable logistic regression was used to compare complications, Kaplan-Meier failure analysis was used to compare the cumulative hospital readmission rates. Two-sample T-testing was used to compare the 90-day cost of care. Results Sarcopenic patients were significantly more likely to experience postoperative shoulder instability (odds ratio (OR) = 2.32, 95% confidence interval (CI), 1.21-4.39) and periprosthetic infection (OR = 3.83, 95% CI, 1.74-8.67) within 1 year of their arthroplasty. Sarcopenic patients were at 25% and 41% greater risk of emergency department presentation and hospital readmission 1-year post-arthroplasty, respectively. Ninty-day total costs were greater among sarcopenics ($16 112.23 vs. 10 679.58, p < 0.001). Conclusion These results are important for orthopaedic surgeons counselling patients with a low muscle mass on the potential for increased complications after undergoing a total shoulder arthroplasty procedure.
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Affiliation(s)
- J Alex Albright
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Edward J Testa
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Kenny Chang
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - E Scott Paxton
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, RI, USA
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Lee HJ, Kim BK, Dan J. Does the proximal humeral bone quality influence alignment after reverse total shoulder arthroplasty with short humeral stems? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2137-2145. [PMID: 38557891 DOI: 10.1007/s00590-024-03909-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE When compared to standard-length humeral stem in reverse total shoulder arthroplasty (RTSA), short humeral stems in RTSA require good proximal humeral metaphyseal bone quality to gain proper and secure fixation during prosthetic implantation. Shorter humeral stems potentially carry more risk of misalignment than standard or long humeral stems. The hypothesis was that misalignment of the short humeral stems is influenced by regional bone quality. METHODS RTSA with a short curved humeral stem with neck-shaft angle (NSA) default of 132.5° was reviewed. The study group included 35 cases at a mean age of 75.97 (± 6.23) years. Deltoid-tuberosity index (DTI) was measured to evaluate proximal humeral bone quality. The deltoid tuberosity index was measured at immediately above position of the upper end of the deltoid tuberosity. Stem alignment was given by the angle measured in degrees between the intramedullary humeral shaft axis and the axis of the humeral implant stem. RESULTS The patient's mean DTI was 1.37 ± 0.16 (median, 1.32; range, 1.12-1.80). 22 patients had poor bone quality (DTI < 1.4), compared to 13 patients with acceptable bone quality (DTI > 1.4). After RTSA, ten humeral components (29%) were neutrally aligned, whereas 25 humeral components (71%) were misaligned. There was no correlation between misalignment and DTI (r = 0.117; p = 0.504). But there was a strong correlation between misalignment and the patient's own NSA (r = - 0.47; p = 0.004). The postoperative stem position and stem misalignment are not associated with functional outcomes (p > 0.05). CONCLUSION The misalignment of the short curved humeral stem frequently occurs. Poor reginal humeral bone quality does not influence misalignment after RTSA with a short humeral stem. Postoperative stem alignment is associated with the patient's preoperative NSA and method of neck cut. The misalignment does not affect functional outcomes for midterm follow-up. Further long-term follow-up studies are needed to confirm its clinical relevance.
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Affiliation(s)
- Ho-Jae Lee
- Department of Orthopaedic Surgery, Gumi CHA Medical Center, CHA University School of Medicine, Sinsi-ro 10gil 12, Kyungsangbuk-do, Gumi-Si, 39314, Republic of Korea
| | - Byung-Kook Kim
- Department of Orthopaedic Surgery, Gumi CHA Medical Center, CHA University School of Medicine, Sinsi-ro 10gil 12, Kyungsangbuk-do, Gumi-Si, 39314, Republic of Korea
| | - Jinmyoung Dan
- Department of Orthopaedic Surgery, Gumi CHA Medical Center, CHA University School of Medicine, Sinsi-ro 10gil 12, Kyungsangbuk-do, Gumi-Si, 39314, Republic of Korea.
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Lim JH, Ahn YS, Kim S, Kim MS. Novel Use of a Fibular Strut Allograft with Fibular Head in an Elderly Patient with Proximal Humeral Fracture and Severe Metaphyseal Comminution: An Alternative to Shoulder Arthroplasty. J Clin Med 2024; 13:2200. [PMID: 38673473 PMCID: PMC11050512 DOI: 10.3390/jcm13082200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Treatment of a comminuted proximal humerus fracture (PHF) in elderly patients with severe osteoporosis is challenging, often leading to arthroplasty (such as hemiarthroplasty or reverse shoulder arthroplasty) as the treatment of choice. However, arthroplasty does not always guarantee favorable outcomes. In contrast, the use of intramedullary fibular strut allografts provides additional reduction stability during locking plate fixation; however, to our knowledge, there is limited literature on the use of fibular strut allografts, including the fibular head. Here we aim to report the advantages of using a fibular strut containing the fibular head in severe osteoporotic PHFs. We present the case of an 88-year-old female patient with severe osteoporosis diagnosed with a left PHF accompanied by severe metaphyseal comminution following a fall from a chair. Rather than shoulder arthroplasty, we performed osteosynthesis using a fibular strut allograft containing the fibular head. At the one-year follow-up after surgery, we observed excellent bony union and a favorable functional outcome without major complications, such as reduction loss. The novel use of a fibular strut allograft containing the fibular head could be promising for PHFs with severe metaphyseal comminution, potentially avoiding the need for arthroplasty.
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Affiliation(s)
- Jun-Hyuk Lim
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Dong-gu, Gwangju 61469, Republic of Korea; (J.-H.L.); (S.K.)
| | - Yeong-Seub Ahn
- Department of Orthopedic Surgery, Good Morning General Hospital, Pyeongtaek 17874, Republic of Korea;
| | - Sungmin Kim
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Dong-gu, Gwangju 61469, Republic of Korea; (J.-H.L.); (S.K.)
| | - Myung-Sun Kim
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Dong-gu, Gwangju 61469, Republic of Korea; (J.-H.L.); (S.K.)
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Ritter D, Denard PJ, Raiss P, Wijdicks CA, Bachmaier S. Preoperative 3-dimensional computed tomography bone density measures provide objective bone quality classifications for stemless anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2024:S1058-2746(23)00887-X. [PMID: 38182017 DOI: 10.1016/j.jse.2023.11.005] [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: 08/29/2023] [Revised: 10/26/2023] [Accepted: 11/12/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Reproducible methods for determining adequate bone densities for stemless anatomic total shoulder arthroplasty (aTSA) are currently lacking. The purpose of this study was to evaluate the utility of preoperative computed tomography (CT) imaging for assessing the bone density of the proximal humerus for supportive differentiation in the decision making for stemless humeral component implantation. It was hypothesized that preoperative 3-dimensional (3-D) CT bone density measures provide objective classifications of the bone quality for stemless aTSA. METHODS A 3-part study was performed that included the analysis of cadaveric humerus CT scans followed by retrospective application to a clinical cohort and classification with a machine learning model. Thirty cadaveric humeri were evaluated with clinical CT and micro-CT (μCT) imaging. Phantom-calibrated CT data were used to extract 3-D regions of interest and defined radiographic scores. The final image processing script was applied retrospectively to a clinical cohort (n = 150) that had a preoperative CT and intraoperative bone density assessment using the "thumb test," followed by placement of an anatomic stemmed or stemless humeral component. Postscan patient-specific calibration was used to improve the functionality and accuracy of the density analysis. A machine learning model (Support vector machine [SVM]) was utilized to improve the classification of bone densities for a stemless humeral component. RESULTS The image processing of clinical CT images demonstrated good to excellent accuracy for cylindrical cancellous bone densities (metaphysis [ICC = 0.986] and epiphysis [ICC = 0.883]). Patient-specific internal calibration significantly reduced biases and unwanted variance compared with standard HU CT scans (P < .0001). The SVM showed optimized prediction accuracy compared with conventional statistics with an accuracy of 73.9% and an AUC of 0.83 based on the intraoperative decision of the surgeon. The SVM model based on density clusters increased the accuracy of the bone quality classification to 87.3% with an AUC of 0.93. CONCLUSIONS Preoperative CT imaging allows accurate evaluation of the bone densities in the proximal humerus. Three-dimensional regions of interest, rescaling using patient-specific calibration, and a machine learning model resulted in good to excellent prediction for objective bone quality classification. This approach may provide an objective tool extending preoperative selection criteria for stemless humeral component implantation.
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Affiliation(s)
- Daniel Ritter
- Department of Orthopedic Research, Arthrex GmbH, Munich, Germany; Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany.
| | | | | | - Coen A Wijdicks
- Department of Orthopedic Research, Arthrex GmbH, Munich, Germany
| | - Samuel Bachmaier
- Department of Orthopedic Research, Arthrex GmbH, Munich, Germany
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Lohre R, Swanson DP, Mahendraraj KA, Elmallah R, Glass EA, Dunn WR, Cannon DJ, Friedman LG, Gaudette JA, Green J, Grobaty L, Gutman M, Kakalecik J, Kloby MA, Konrade EN, Knack MC, Loveland A, Mathew JI, Myhre L, Nyfeler J, Parsell DE, Pazik M, Polisetty TS, Ponnuru P, Smith KM, Sprengel KA, Thakar O, Turnbull L, Vaughan A, Wheelwright JC, Abboud J, Armstrong A, Austin L, Brolin T, Entezari V, Garrigues GE, Grawe B, Gulotta LV, Hobgood R, Horneff JG, Iannotti J, Khazzam M, King JJ, Kirsch JM, Levy JC, Murthi A, Namdari S, Nicholson GP, Otto RJ, Ricchetti ET, Tashjian R, Throckmorton T, Wright T, Jawa A. Risk factors of acromial and scapular spine stress fractures differ by indication: a study by the ASES Complications of Reverse Shoulder Arthroplasty Multicenter Research Group. J Shoulder Elbow Surg 2023; 32:2483-2492. [PMID: 37330167 DOI: 10.1016/j.jse.2023.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/20/2023] [Accepted: 05/06/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Both patient and implant related variables have been implicated in the incidence of acromial (ASF) and scapular spine fractures (SSF) following reverse shoulder arthroplasty (RSA); however, previous studies have not characterized nor differentiated risk profiles for varying indications including primary glenohumeral arthritis with intact rotator cuff (GHOA), rotator cuff arthropathy (CTA), and massive irreparable rotator cuff tear (MCT). The purpose of this study was to determine patient factors predictive of cumulative ASF/SSF risk for varying preoperative diagnosis and rotator cuff status. METHODS Patients consecutively receiving RSA between January 2013 and June 2019 from 15 institutions comprising 24 members of the American Shoulder and Elbow Surgeons (ASES) with primary, preoperative diagnoses of GHOA, CTA and MCT were included for study. Inclusion criteria, definitions, and inclusion of patient factors in a multivariate model to predict cumulative risk of ASF/SSF were determined through an iterative Delphi process. The CTA and MCT groups were combined for analysis. Consensus was defined as greater than 75% agreement amongst contributors. Only ASF/SSF confirmed by clinical and radiographic correlation were included for analysis. RESULTS Our study cohort included 4764 patients with preoperative diagnoses of GHOA, CTA, or MCT with minimum follow-up of 3 months (range: 3-84). The incidence of cumulative stress fracture was 4.1% (n = 196). The incidence of stress fracture in the GHOA cohort was 2.1% (n = 34/1637) compared to 5.2% (n = 162/3127) (P < .001) in the CTA/MCT cohort. Presence of inflammatory arthritis (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.08-7.78; P = .035) was the sole predictive factor of stress fractures in GHOA, compared with inflammatory arthritis (OR 1.86, 95% CI 1.19-2.89; P = .016), female sex (OR 1.81, 95% CI 1.20-2.72; P = .007), and osteoporosis (OR 1.56, 95% CI 1.02-2.37; P = .003) in the CTA/MCT cohort. CONCLUSION Preoperative diagnosis of GHOA has a different risk profile for developing stress fractures after RSA than patients with CTA/MCT. Though rotator cuff integrity is likely protective against ASF/SSF, approximately 1/46 patients receiving RSA with primary GHOA will have this complication, primarily influenced by a history of inflammatory arthritis. Understanding risk profiles of patients undergoing RSA by varying diagnosis is important in counseling, expectation management, and treatment by surgeons.
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Affiliation(s)
- Ryan Lohre
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston Shoulder Institute, Boston, MA, USA
| | - Daniel P Swanson
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Kuhan A Mahendraraj
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Randa Elmallah
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Evan A Glass
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Warren R Dunn
- Fondren Orthopaedic Group, Orthopaedic Surgery, Houston, TX, USA
| | - Dylan J Cannon
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | - Lisa Gm Friedman
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Jaina A Gaudette
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - John Green
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Lauren Grobaty
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jaquelyn Kakalecik
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael A Kloby
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elliot N Konrade
- University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, Memphis, TN, USA
| | - Margaret C Knack
- University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, Memphis, TN, USA
| | - Amy Loveland
- MedStar Union Memorial Hospital, Baltimore, MD, USA
| | | | - Luke Myhre
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jacob Nyfeler
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Doug E Parsell
- Mississippi Sports Medicine and Orthopaedic Surgery, Jackson, MS, USA
| | - Marissa Pazik
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | | | | | - Karch M Smith
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Ocean Thakar
- MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lacie Turnbull
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | | | | | - Joseph Abboud
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | | | - Luke Austin
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Tyler Brolin
- University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, Memphis, TN, USA
| | - Vahid Entezari
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Grawe
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Rhett Hobgood
- Mississippi Sports Medicine and Orthopaedic Surgery, Jackson, MS, USA
| | | | - Joseph Iannotti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jacob M Kirsch
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Jonathan C Levy
- Levy Shoulder Center at Paley Orthopedic and Spine Institute, Boca Raton, FL, USA
| | - Anand Murthi
- MedStar Union Memorial Hospital, Baltimore, MD, USA
| | | | - Gregory P Nicholson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Randall J Otto
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Tashjian
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Thomas Throckmorton
- University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, Memphis, TN, USA
| | - Thomas Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA.
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Hochreiter B, Selman F, Calek AK, Kriechling P, Götschi T, Grubhofer F, Wieser K, Bouaicha S. Why is female gender associated with poorer clinical outcomes after reverse total shoulder arthroplasty? J Shoulder Elbow Surg 2023; 32:2355-2365. [PMID: 37276918 DOI: 10.1016/j.jse.2023.04.034] [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: 01/25/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION There is a lack of gender-specific research after reverse total shoulder arthroplasty (RTSA). Although previous studies have documented worse outcomes in women, a more thorough understanding of why outcomes may differ is needed. We therefore asked: (1) Are there gender-specific differences in preoperative and postoperative clinical scores, complications, surgery-related parameters, and demographics? (2) Is female gender an independent risk factor for poorer clinical outcomes after RTSA? (3) If so, why is female gender associated with poorer outcomes after RTSA? MATERIALS AND METHODS Between 2005 and 2019, 987 primary RTSAs were performed in our institution. After exclusion criteria were applied, data of 422 female and 271 male patients were analyzed. Clinical outcomes (absolute/relative Constant Score [a/rCS] and Subjective Shoulder Value [SSV]), complications (intra- and/or postoperative fracture, loosening), surgery-related parameters (indication, implant-related characteristics), and demographics (age, gender, body mass index, and number of previous surgeries) were evaluated. Preoperative and postoperative radiographs were analyzed (critical shoulder angle, deltoid-tuberosity index, reverse shoulder angle, lateralization shoulder angle, and distalization shoulder angle). RESULTS Preoperative clinical scores (aCS, rCS, SSV, and pain level) and postoperative clinical outcomes (aCS and rCS) were significantly worse in women. However, the improvement between preoperative and postoperative outcomes was significantly higher in female patients for rCS (P = .037), internal rotation (P < .001), and regarding pain (P < .001). Female patients had a significantly higher number of intraoperative and postoperative fractures (24.9% vs. 11.4%, P < .001). The proportion of female patients with a deltoid-tuberosity index <1.4 was significantly higher than males (P = .01). Female gender was an independent negative predictor for postoperative rCS (P = .047, coefficient -0.084) and pain (P = .017, coefficient -0.574). In addition to female sex per se being a predictive factor of worse outcomes, females were significantly more likely to meet 2 of the 3 most significant predictive factors: (1) significantly worse preoperative clinical scores and (2) higher rate of intra- and/or postoperative fractures. CONCLUSIONS Female sex is a very weak, but isolated, negative predictive factor that negatively affects the objective clinical outcome (rCS) after RTSA. However, differences did not reach the minimal clinically important difference, and it is not a predictor for the subjective outcome (SSV). The main reason for the worse outcome in female patients seems to be a combination of higher preoperative disability and higher incidence of fractures. To improve the outcome of women, all measures that contribute to the reduction of perioperative fracture risk should be used.
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Affiliation(s)
- Bettina Hochreiter
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Farah Selman
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Kriechling
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian Grubhofer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Samy Bouaicha
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Lu H, Jin E, Xie H, Fu J, Chen X, Liu W, Yang Q, Yu F. Incidence and risk factors of in-hospital prosthesis-related complications following total shoulder arthroplasty. J Orthop Surg (Hong Kong) 2023; 31:10225536231214055. [PMID: 37971330 DOI: 10.1177/10225536231214055] [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] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The occurrence of prosthesis-related complications after total shoulder arthroplasty is devastating and costly. The purpose was to determine the incidence and risk of in-hospital prosthesis-related complications after total shoulder arthroplasty utilizing a large-scale sample database. METHODS A retrospective database analysis was performed based on Nationwide Inpatient Sample from 2010 to 2014. Patients who underwent total shoulder arthroplasty were included. Patient demographics, hospital characteristics, length of stay, economic indicators, in-hospital mortality, comorbidities, and peri-operative complications were evaluated. RESULTS A total of 34,198 cases were capture from the Nationwide Inpatient Sample database. There were 343 cases of in-hospital prosthesis-related complications after total shoulder arthroplasty and the overall incidence was 1%, with a more than 2.5-fold decrease from 2010 to 2014. Dislocation was the most common category among prosthesis-related complications (0.1%). The occurrence of in-hospital prosthesis-related complications was associated with significantly more total charges and slightly longer length of stay while less usage of Medicare. Risk factors of prosthesis-related complications were identified including younger age (<64 years), female, the native American, hospital in the South, alcohol abuse, depression, uncomplicated diabetes, diabetes with chronic complications, fluid and electrolyte disorders, metastatic cancer, neurological disorders, and renal failure. Interestingly, advanced age (≥65 years) and proprietary hospital were found as protective factors. Furthermore, prosthesis-related complications were associated with aseptic necrosis, rheumatoid arthritis, rotator cuff tear arthropathy, Parkinson's disease, prior shoulder arthroscopy, and blood transfusion. CONCLUSIONS It is of benefit to study risk factors of prosthesis-related complications following total shoulder arthroplasty to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.
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Affiliation(s)
- Huishan Lu
- Department of Nursing, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, China
| | - Enyou Jin
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macao, China
| | - Hao Xie
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinlang Fu
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianhui Chen
- Division of Orthopaedic Surgery, Department of Orthopedic Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Wenqian Liu
- Division of Critical Care Medicine, Department of HuiQiao Medical Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fang Yu
- Division of Orthopaedic Surgery, People's Hospital of Ganzhou, Ganzhou, China
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Daher M, Fares MY, Boufadel P, Khanna A, Zalaquett Z, Abboud JA. Osteoporosis in the Setting of Shoulder Arthroplasty: A Narrative Review. Geriatr Orthop Surg Rehabil 2023; 14:21514593231182527. [PMID: 37325699 PMCID: PMC10265344 DOI: 10.1177/21514593231182527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Patients who undergo shoulder surgery are frequently affected by osteoporosis and osteopenia, and the prevalence of this association is expected to increase due to the growing number of elderly individuals undergoing these procedures. It may be advisable to conduct a preoperative DXA scan for orthopedic surgical candidates at high risk, to detect those who could benefit from early intervention and avoid any related adverse events. Some of these complications include periprosthetic fractures, infection, subsequent fragility fractures, and have an all-cause revision arthroplasty at 2 years post-op. Some studies analyzed the beneficence of antiresorptive medications pre-operatively but the latter did not show favorable outcomes. Surgical management may include cementing components of the prosthesis as well as modifying the diameter of the shoulder stem. Nevertheless, more studies are needed to evaluate the efficacy of any intervention, whether medical or surgical, to avoid any shoulder arthroplasty related-complication that may be precipitated by the reduced bone mineral density.
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Affiliation(s)
- Mohammad Daher
- Orthopedic department, Hôtel Dieu de France, Beirut, Lebanon
| | - Mohamad Y. Fares
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Peter Boufadel
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Akshay Khanna
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ziad Zalaquett
- Orthopedic department, Hôtel Dieu de France, Beirut, Lebanon
| | - Joseph A. Abboud
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
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9
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Gordon AM, Horn AR, Lam AW, Sheth BK, Choueka J, Sadeghpour R. The Association of Benign Prostatic Hyperplasia on Postoperative Complications and Periprosthetic Joint Infections Following Total Shoulder Arthroplasty. Shoulder Elbow 2023; 15:188-194. [PMID: 37035608 PMCID: PMC10078814 DOI: 10.1177/17585732221081012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/15/2022]
Abstract
Background A recently proposed risk factor for periprosthetic joint infections (PJI) in men is benign prostatic hyperplasia (BPH). The objective was to explore the association of BPH on 1) 90-day complications, 2) length of stay (LOS), 3) readmission rates, and 4) healthcare expenditures following total shoulder arthroplasty (TSA). Methods A retrospective query was performed using a nationwide claims database from January 2005 to March 2014 for male patients undergoing primary TSA. The study cohort included 5067 patients with BPH while 50,720 patients served as the comparison cohort. Logistic regression determined the association of BPH on complications and readmissions. A p value less than 0.001 was significant. Results Patients with BPH had higher incidence and odds (36.8 vs. 6.2%; OR: 2.73, p < 0.0001) of all ninety-day medical complications including PJIs (0.49 vs. 0.32%; OR: 1.54, p < 0.001). BPH patients had longer in-hospital LOS (3- vs. 2-days, p < 0.0001). Study group patients had higher 90-day episode of care reimbursements ($13,653 vs. $12,688), p < 0.0001). Conclusions BPH is associated with increased complications and healthcare expenditures following total shoulder arthroplasty. The investigation can be used to educate BPH patients of the possible adverse events which may occur within ninety-days following primary TSA for the treatment of glenohumeral osteoarthritis.
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Affiliation(s)
- Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Andrew R Horn
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Aaron W Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Bhavya K Sheth
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Jack Choueka
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Ramin Sadeghpour
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
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10
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Binkley N, Nickel B, Anderson PA. Periprosthetic fractures: an unrecognized osteoporosis crisis. Osteoporos Int 2023; 34:1055-1064. [PMID: 36939852 DOI: 10.1007/s00198-023-06695-w] [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: 11/16/2022] [Accepted: 02/02/2023] [Indexed: 03/21/2023]
Abstract
Total joint replacement is common and increasing. Many of these patients have low bone mineral density preoperatively, and arthroplasty leads to bone loss. As falls are common before and after arthroplasty, it is unsurprising that periprosthetic fractures, defined as those associated with an orthopedic device, whether a joint replacement or other internal fixation devices, are not rare. These fractures engender morbidity and mortality comparable to osteoporosis-related hip fractures but remain largely unrecognized and untreated by osteoporosis/metabolic bone disease clinicians. Indeed, recent osteoporosis guidelines are silent regarding periprosthetic fractures. The purposes of this clinical review are to briefly describe the epidemiology of arthroplasty procedures and periprosthetic fractures, raise awareness that these fractures are osteoporosis-related, and suggest approaches likely to reduce their occurrence. Notably, bone health evaluation is essential following the occurrence of a periprosthetic fracture to reduce subsequent fracture risk. Importantly, in addition to such secondary fracture prevention, primary prevention, i.e., bone health assessment and optimization prior to elective orthopedic procedures, is appropriate.
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Affiliation(s)
- Neil Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA.
| | - Brian Nickel
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, USA
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, USA
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11
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White CA, Quinones A, Tang JE, Butler LR, Duey AH, Kim JS, Cho SK, Cagle PJ. A national analysis of the effect alcohol use disorder has on short-term complications and readmissions following total shoulder arthroplasty. J Orthop 2023; 35:13-17. [PMID: 36338316 PMCID: PMC9633869 DOI: 10.1016/j.jor.2022.10.010] [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: 08/08/2022] [Revised: 09/21/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Alcohol use disorder has been associated with broad health consequences that may interfere with healing after total shoulder arthroplasty. The aim of this study was to explore the impact of alcohol use disorder on readmissions and complications following total shoulder arthroplasty. Methods We used data from the Healthcare Cost and Utilization Project National Readmissions Database (NRD) from 2016 to 2018. Patients were included based on International Classification of Diseases, 10th Revision (ICD-10) procedure codes for anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA). Patients with an alcohol use disorder (AUD) were identified using the ICD-10 diagnosis code F10.20. Demographics, complications, and 30-day and 90-day readmission were collected for all patients. A univariate logistic regression was performed to investigate AUD as a factor affecting readmission and complication rates. A multivariate logistic regression model was created to assess the impact of alcohol use disorder on complications and readmission while controlling for demographic factors. Results In total, 164,527 patients were included, and 503 (0.3%) patients had a prior diagnosis of AUD. Revision surgery was more common in patients with an alcohol use disorder (8.8% vs. 6.2%; p = 0.022). Postoperative infection (p = 0.026), dislocation (p = 0.025), liver complications (p < 0.01), and 90-day readmission (p < 0.01) were more common in patients with a diagnosed AUD. On multivariate analysis, patients with an AUD were found to be at increased odds for liver complications (OR: 46.8; 95% CI: [32.8, 66.8]; p < 0.01). Comparatively, mean age, length of stay, and over healthcare costs were also higher for patients with an AUD. Conclusion Patients with a diagnosis of AUD were more likely to suffer from shoulder dislocation, liver complications, and 90-day readmission, while also being younger and having longer hospital stays. Therefore, surgeons should take caution to anticipate and prevent complications and readmissions following total shoulder arthroplasty in patients with an AUD.
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Affiliation(s)
- Christopher A. White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Addison Quinones
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Justin E. Tang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Liam R. Butler
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Akiro H. Duey
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Jun S. Kim
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Samuel K. Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Paul J. Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
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Italia K, Launay M, Gilliland L, Nielsen J, Pareyon R, Hollman F, Salhi A, Maharaj J, Jomaa M, Cutbush K, Gupta A. Single-Stage Revision Reverse Shoulder Arthroplasty: Preoperative Planning, Surgical Technique, and Mixed Reality Execution. J Clin Med 2022; 11:jcm11247422. [PMID: 36556038 PMCID: PMC9788296 DOI: 10.3390/jcm11247422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Revision shoulder arthroplasty is increasing with the number of primary shoulder replacements rising globally. Complex primary and revisions of shoulder arthroplasties pose specific challenges for the surgeon, which must be addressed preoperatively and intraoperatively. This article aimed to present strategies for the management of revision of shoulder arthroplasties through a single-stage approach. Preoperatively, patient factors, such as age, comorbidities, and bone quality, should be considered. The use of planning software can aid in accurately evaluating implants in situ and predict bony anatomy that will remain after explantation during the revision surgery. The planning from such software can then be executed with the help of mixed reality technology to allow accurate implant placement. Single-stage revision is performed in two steps (debridement as first step, implantation and reconstruction as the second step), guided by the following principles: adequate debridement while preserving key soft tissue attachments (i.e., rotator cuff, pectoralis major, latissimus dorsi, deltoid), restoration of glenoid joint line using bone grafting, restoration of humeral length, reconstruction and/or reattachment of soft tissues, and strict compliance with the postoperative antibiotic regimen. Preliminary results of single-stage revision shoulder arthroplasty show improvement in patient outcomes (mean 1 year), successful treatment of infection for those diagnosed with periprosthetic joint infection, and improved cost-benefit parameters for the healthcare system.
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Affiliation(s)
- Kristine Italia
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Correspondence: (K.I.); or (A.G.); Tel.: +61-7-3208-5552 (A.G.)
| | - Marine Launay
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Akunah, Brisbane, QLD 4120, Australia
| | - Luke Gilliland
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Akunah, Brisbane, QLD 4120, Australia
| | - James Nielsen
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Akunah, Brisbane, QLD 4120, Australia
| | - Roberto Pareyon
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Greenslopes Private Hospital, Brisbane, QLD 4120, Australia
- Brisbane Private Hospital, Brisbane, QLD 4000, Australia
| | - Freek Hollman
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Greenslopes Private Hospital, Brisbane, QLD 4120, Australia
- Brisbane Private Hospital, Brisbane, QLD 4000, Australia
| | - Asma Salhi
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Akunah, Brisbane, QLD 4120, Australia
| | - Jashint Maharaj
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Mohammad Jomaa
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Greenslopes Private Hospital, Brisbane, QLD 4120, Australia
- Brisbane Private Hospital, Brisbane, QLD 4000, Australia
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Brisbane Private Hospital, Brisbane, QLD 4000, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Akunah, Brisbane, QLD 4120, Australia
- Greenslopes Private Hospital, Brisbane, QLD 4120, Australia
- Correspondence: (K.I.); or (A.G.); Tel.: +61-7-3208-5552 (A.G.)
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13
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Andersen L, Krueger D, Bernatz J, Binkley N, Anderson PA, Grogan B. Humeral BMD can be Measured With DXA and Is Lower in the Surgical Arm After Total Shoulder Arthroplasty. J Clin Densitom 2022; 25:448-455. [PMID: 36114106 DOI: 10.1016/j.jocd.2022.08.005] [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: 06/16/2022] [Accepted: 08/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND As arthroplasty leads to bone loss, we hypothesized that humeral bone mineral density (BMD) is lower after total shoulder arthroplasty (TSA) in the operative versus non-operative arm. However, there is no clinical approach to measure humeral BMD with dual-energy x-ray absorptiometry (DXA). The purposes of this pilot study were to develop DXA methodology to measure humerus BMD, propose humerus regions of interest (ROIs), compare TSA BMD to the non-operative arm, correlate humeral BMD with standard sites, and evaluate measurement reproducibility. METHODOLOGY Thirty-eight adults 1-5 years post-TSA had standard clinical DXA scans plus full humerus scans using the atypical femur fracture feature; precision was assessed in a subset (n = 32). Six custom ROIs were used to measure BMD throughout the humerus. Radius and humeral BMD were compared between arms by paired t-test and correlated ipsilaterally using Pearson's Correlation. Custom ROI BMD precision was assessed using the International Society for Clinical Densitometry (ISCD) advanced precision calculator. RESULTS Study included 38 subjects (24M/14F), with mean (SD) age and time post-surgery of 69.6 (7.7) years and 2.5 (1.3) years respectively. BMD was lower (p < 0.01) at all custom humerus sites (3.8% to 8.2%) on the surgical side but not different at radius sites. Humeral BMD correlated positively with ipsilateral ultra-distal and 1/3 radius (r = 0.54 to 0.86; p < 0.05). Custom BMD precision (%CV) ranged from 6.0-16.0%. CONCLUSIONS Humerus BMD can be measured using DXA and is lower in the TSA arm. Radius BMD correlated with humeral BMD but was not lower in the surgical arm. BMD precision was worse than usual clinical sites; use of software optimized for the femur is a notable limitation and likely contributes to suboptimal precision. Further study to assess the clinical utility of humeral BMD is needed. Automation and optimization of these measurements should improve precision.
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Affiliation(s)
- Lucas Andersen
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison.
| | - Diane Krueger
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison
| | - James Bernatz
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison
| | - Neil Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison
| | - Brian Grogan
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison
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14
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Gordon AM, Diamond KB, Ashraf AM, Magruder ML, Sadeghpour R, Choueka J. Benign prostatic hyperplasia is associated with increased 90-day medical complications but not peri-prosthetic joint infections following reverse shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03344-6. [PMID: 35951116 DOI: 10.1007/s00590-022-03344-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Studies have shown male sex to be a predisposing factor for peri-prosthetic joint infections (PJIs). Symptomatic benign prostatic hyperplasia (BPH) has been suggested as an additional risk for PJI. This study aimed to assess the impact of BPH on (1) lengths of stay (LOS), (2) complications (medical and implant-related), (3) readmission rates, and (4) healthcare expenditures after reverse shoulder arthroplasty (RSA). METHODS Utilizing a nationwide sample from the 2010-2020 PearlDiver insurance database, an analysis was performed retrospectively for all males who underwent primary RSA. Males with BPH (n = 2,184) represented the study group and were ratio-matched with men without a history of BPH (n = 10,832) in a 1:5 manner by medical comorbidities. T-tests compared LOS and healthcare expenditures. Multivariate logistic regression models were used to determine the effect of BPH on 90-day medical complications, 2-year implant complications, and readmissions. A p value less than 0.001 was statistically significant. RESULTS In-hospital LOS (1.96 days vs. 1.99 days, p = 0.683) did not significantly differ between cohorts. Males with BPH had significantly greater occurrence and odds (34.3% vs. 21.2%, odds ratio (OR):1.84, p < 0.0001) of all 90-day medical complications, including urinary tract infections (9.3% vs. 3.1%, OR:3.23, p < 0.0001), pneumonias (6.0% vs. 3.9%, OR:1.61, p < 0.0001), and acute kidney injuries (7.7% vs. 5.0%, OR:1.60, p < 0.0001). Two-year implant-related complications were comparable between study and control groups (12.2% vs 10.9%, OR:1.14, p = 0.073), including PJIs (2.3% vs. 2.2%, OR:1.02, p = 0.874). Readmission rates (1.88% vs. 2.11%, p = 0.482) and average global 90-day reimbursements ($26,301 vs. $24,399), p = 0.535) were similar between men with and without BPH. DISCUSSION Males with a history of BPH have greater rates of medical complications, including UTIs and acute kidney injuries, within 90 days following RSA. BPH does not appear to be a risk factor for 2-year implant-related complications including PJIs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Adam M Gordon
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA.
| | - Keith B Diamond
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Asad M Ashraf
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Matthew L Magruder
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Ramin Sadeghpour
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Jack Choueka
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
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15
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Artificial Neural Networks Can Predict Early Failure of Cementless Total Hip Arthroplasty in Patients With Osteoporosis. J Am Acad Orthop Surg 2022; 30:467-475. [PMID: 35202042 DOI: 10.5435/jaaos-d-21-00775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/18/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) done in the aging population is associated with osteoporosis-related complications. The altered bone density in osteoporotic patients is a risk factor for revision surgery. This study aimed to develop and validate machine learning (ML) models to predict revision surgery in patients with osteoporosis after primary noncemented THA. METHODS We retrospectively reviewed a consecutive series of 350 patients with osteoporosis (T-score less than or equal to -2.5) who underwent primary noncemented THA at a tertiary referral center. All patients had a minimum 2-year follow-up (range: 2.1 to 5.6). Four ML algorithms were developed to predict the probability of revision surgery, and these were assessed by discrimination, calibration, and decision curve analysis. RESULTS The overall incidence of revision surgery was 5.2% at a mean follow-up of 3.7 years after primary noncemented THA in osteoporotic patients. Revision THA was done because of periprosthetic fracture in nine patients (50%), aseptic loosening/subsidence in five patients (28%), periprosthetic joint infection in two patients (11%) and dislocation in two patients (11%). The strongest predictors for revision surgery in patients after primary noncemented THA were female sex, BMI (>35 kg/m2), age (>70 years), American Society of Anesthesiology score (≥3), and T-score. All four ML models demonstrated good model performance across discrimination (AUC range: 0.78 to 0.81), calibration, and decision curve analysis. CONCLUSION The ML models presented in this study demonstrated high accuracy for the prediction of revision surgery in osteoporotic patients after primary noncemented THA. The presented ML models have the potential to be used by orthopaedic surgeons for preoperative patient counseling and optimization to improve the outcomes of primary noncemented THA in osteoporotic patients.
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16
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Baessler A, Smith PJ, Brolin TJ, Neel RT, Sen S, Zhu R, Bernholt D, Azar FM, Throckmorton TW. Preoperative opioid usage predicts markedly inferior outcomes 2 years after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:608-615. [PMID: 34474138 DOI: 10.1016/j.jse.2021.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) has proved to be a highly effective treatment for rotator cuff-deficient conditions and other end-stage shoulder pathologies. With value-based care emerging, identifying predictive factors of outcomes is of great interest. Although preoperative opioid use has been shown to predict inferior outcomes after anatomic total shoulder arthroplasty and rotator cuff repair, there is a paucity of data regarding its effect on outcomes after RTSA. We analyzed a series of RTSAs to determine the influence of preoperative opioid use on clinical and radiographic outcomes at a minimum of 2 years' follow-up. METHODS A retrospective review of primary RTSA patient data revealed 264 patients with ≥2 years of clinical and radiographic follow-up. Patients were classified as preoperative opioid users (71 patients) if they had taken narcotic pain medication for a minimum of 3 months prior to surgery or as opioid naive (193 patients) at the time of surgery. Assessments included preoperative and postoperative visual analog scale pain scores, American Shoulder and Elbow Surgeons scores, strength, and range of motion, as well as complications and revisions. Radiographs were analyzed for signs of loosening or mechanical failure. The Mann-Whitney U and Fisher exact tests were used for comparisons between groups. Statistical significance was set at P < .05. RESULTS The mean patient age was 69.9 years, and the mean follow-up time was 2.8 years. Opioid users were significantly younger (66.1 years vs. 70.7 years, P < .001) at the time of surgery and had significantly higher preoperative rates of mood disorders, chronic pain disorders, and disability status (all P < .05). Postoperatively, opioid users had inferior visual analog scale pain scores (2.59 vs. 1.25, P < .001), American Shoulder and Elbow Surgeons scores (63.2 vs. 75.2, P < .001), active forward elevation (P < .001), and internal and external rotational shoulder strength (all P < .05) compared with opioid-naive patients. Periprosthetic radiolucency (8.45% vs. 2.07%, P = .026) and subsequent revision arthroplasty (14.1% vs. 4.66%, P = .014) occurred more frequently in opioid users than in opioid-naive patients. Both groups improved from baseline preoperatively to most recent follow-up in terms of functional outcomes and pain. CONCLUSION Preoperative opioid use portended markedly inferior clinical outcomes in patients undergoing RTSA. Additionally, opioid users had significantly increased rates of periprosthetic radiolucency and revision. Preoperative opioid use appears to be a significant marker for adverse outcomes after RTSA.
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Affiliation(s)
- Aaron Baessler
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Patrick J Smith
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Tyler J Brolin
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Robert T Neel
- University of Tennessee Health Science Center School of Medicine, Memphis, TN, USA
| | - Saunak Sen
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rongshun Zhu
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Bernholt
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Frederick M Azar
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Thomas W Throckmorton
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
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Bjelić D, Finšgar M. Bioactive coatings with anti-osteoclast therapeutic agents for bone implants: Enhanced compliance and prolonged implant life. Pharmacol Res 2022; 176:106060. [PMID: 34998972 DOI: 10.1016/j.phrs.2022.106060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/24/2021] [Accepted: 01/03/2022] [Indexed: 12/18/2022]
Abstract
The use of therapeutic agents that inhibit bone resorption is crucial to prolong implant life, delay revision surgery, and reduce the burden on the healthcare system. These therapeutic agents include bisphosphonates, various nucleic acids, statins, proteins, and protein complexes. Their use in systemic treatment has several drawbacks, such as side effects and insufficient efficacy in terms of concentration, which can be eliminated by local treatment. This review focuses on the incorporation of osteoclast inhibitors (antiresorptive agents) into bioactive coatings for bone implants. The ability of bioactive coatings as systems for local delivery of antiresorptive agents to achieve optimal loading of the bioactive coating and its release is described in detail. Various parameters such as the suitable concentrations, release times, and the effects of the antiresorptive agents on nearby cells or bone tissue are discussed. However, further research is needed to support the optimization of the implant, as this will enable subsequent personalized design of the coating in terms of the design and selection of the coating material, the choice of an antiresorptive agent and its amount in the coating. In addition, therapeutic agents that have not yet been incorporated into bioactive coatings but appear promising are also mentioned. From this work, it can be concluded that therapeutic agents contribute to the biocompatibility of the bioactive coating by enhancing its beneficial properties.
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Affiliation(s)
- Dragana Bjelić
- Faculty of Chemistry and Chemical Engineering, University of Maribor, Smetanova ulica 17, 2000 Maribor, Slovenia.
| | - Matjaž Finšgar
- Faculty of Chemistry and Chemical Engineering, University of Maribor, Smetanova ulica 17, 2000 Maribor, Slovenia.
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18
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A novel revision system for complex pelvic defects utilizing 3D-printed custom prosthesis. J Orthop Translat 2022; 31:102-109. [PMID: 34976730 PMCID: PMC8683605 DOI: 10.1016/j.jot.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/31/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background Thus far, the hip revision surgery has been widely used and promoted, and the technology has been constantly innovated, such as tissue engineering, 3D printing prosthesis, etc. However, traditional standardized prosthesis, allograft, autograft, bone cement and reinforcing ring are still the main treatment methods in the mainstream pelvic defects classification systems for hip revision. In addition, the mainstream classification systems are still mainly focus on the peri-acetabulum, but less on the large-scale complex pelvic defects that widely affecting the regions far away from the acetabulum, which also have a significant impact on the holistic biomechanical properties of pelvis. Methods After integrating the design experience of custom prostheses and the understanding of biomechanical properties of pelvis, an innovative pelvic defects classification for custom revision was preliminarily proposed, and was practiced in surgeries. Some typical cases were chosen for elucidation in this study, and two observers each evaluated their CT data independently twice. Intraobserver and interobserver agreement were calculated using the kappa statistic to evaluate the reliability. The pelvis defects were classified into five types and two subtypes. The corresponding reconstruction principles, as the main basis to support the classification, were also described in detail. Prosthesis position examination and Harris hip score were utilized to evaluate the clinical outcome. Results The installed prostheses resulted in high concordance with preoperative position planning, significantly improved Harris score, low postoperative complication rate and no re-revision case. In addition, The interobserver and intraobserver agreement were both excellent. Conclusion The presenting revision system for complex pelvic defects utilizing 3D-printed custom prosthesis and corresponding classification of pelvic defects can preliminarily guide patients’ grouping and prosthesis design, and may potentially provide an innovative, feasible, and efficient basis for complex total hip arthroplasty (THA) revision. Translational potential statement This study provides a novel method for prosthetic revision of peri-acetabular pelvic defects, and is expected to systematically improve the efficiency of prosthesis design and surgery in clinical practice.
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Horn AR, Diamond KB, Ng MK, Vakharia RM, Mont MA, Erez O. The Association of Alcohol Use Disorder with Perioperative Complications following Primary Total Hip Arthroplasty. Hip Pelvis 2021; 33:231-238. [PMID: 34938693 PMCID: PMC8654594 DOI: 10.5371/hp.2021.33.4.231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose Alcohol use disorder is a leading mental health disorder in the United States. Few studies evaluating the association of alcohol use disorder following primary total hip arthroplasty (THA) have been reported. Therefore, the purpose of this study was to determine whether patients with alcohol use disorder undergoing primary THA have higher rates of: 1) in-hospital lengths of stay (LOS); 2) complications (medical/implant-related); and 3) costs. Materials and Methods Using a nationwide claims database from January 1st, 2005 to March 31st, 2014, patients with alcohol use disorder undergoing primary THA were identified and matched to a comparison group according to age, sex, and various comorbidities, resulting in 230,467 patients who were included in the study (n=38,416) and a matched-cohort (n=192,051). Outcomes of interest included comparison of LOS, 90-day medical and 2-year implant-related complications, and costs. A P-value less than 0.002 was considered statistically significant. Results Patients with alcohol use disorder had longer in-hospital LOS (4 days vs 3 days; P<0.0001) as well as higher frequency and odds ratio (OR) of 90-day medical (45.94% vs 12.25%; OR, 2.89; P<0.0001) and 2-year implant-related complications (17.71% vs 8.46%; OR, 1.97; P<0.0001). Patients in the study group incurred higher 90-day costs of care ($17,492.63 vs $14,921.88; P<0.0001). Conclusion With the growing prevalence of alcohol use disorder in the United States, the current investigation can be utilized to evaluate the need for interventions prior to THA which can potentially minimize the rates of morbidity and mortality within this population.
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Affiliation(s)
- Andrew R Horn
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Keith B Diamond
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Rushabh M Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Orry Erez
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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20
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Huddleston HP, Kurtzman JS, Gedailovich S, Koehler SM, Aibinder WR. The rate and reporting of fracture after biceps tenodesis: A systematic review. J Orthop 2021; 28:70-85. [PMID: 34880569 PMCID: PMC8633822 DOI: 10.1016/j.jor.2021.11.014] [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: 08/22/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The purpose of this systematic review was to (1) define the cumulative humerus fracture rate after BT and (2) compare how often fracture rate was reported compared to other complications. METHODS A systematic review was performed using the PRISMA guidelines. RESULTS 39 studies reported complications and 30 reported no complications. Of the 39 studies that reported complications, 5 studies reported fracture after BT (n = 669, cumulative incidence of 0.53%). The overall non-fracture complication rate was 12.9%. DISCUSSION Due to the relatively high incidence of fracture, surgeons should ensure that this complication is disclosed to patients undergoing BT.
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Affiliation(s)
- Hailey P. Huddleston
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - Joey S. Kurtzman
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - Samuel Gedailovich
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - Steven M. Koehler
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - William R. Aibinder
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
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21
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Mahendraraj KA, Abboud J, Armstrong A, Austin L, Brolin T, Entezari V, Friedman L, Garrigues GE, Grawe B, Gulotta L, Gutman M, Hart PA, Hobgood R, Horneff JG, Iannotti J, Khazzam M, King J, Kloby MA, Knack M, Levy J, Murthi A, Namdari S, Okeke L, Otto R, Parsell DE, Polisetty T, Ponnuru P, Ricchetti E, Tashjian R, Throckmorton T, Townsend C, Wright M, Wright T, Zimmer Z, Menendez ME, Jawa A. Predictors of acromial and scapular stress fracture after reverse shoulder arthroplasty: a study by the ASES Complications of RSA Multicenter Research Group. J Shoulder Elbow Surg 2021; 30:2296-2305. [PMID: 33677115 DOI: 10.1016/j.jse.2021.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/31/2021] [Accepted: 02/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acromial (ASF) and scapular spine (SSF) stress fractures are well-recognized complications of reverse shoulder arthroplasty (RSA), but much of the current data are derived from single-center or single-implant studies with limited generalizability. This study from the American Shoulder and Elbow Surgeons (ASES) Complications of Reverse Shoulder Arthroplasty Multicenter Research Group determined the incidence of ASF/SSF after RSA and identified preoperative patient characteristics associated with their occurrence. METHOD Fifteen institutions including 21 ASES members across the United States participated in this study. Patients undergoing either primary or revision RSA between January 2013 and June 2019 with a minimum 3-month follow-up were included. All definitions and inclusion criteria were determined using the Delphi method, an iterative survey process involving all primary investigators. Consensus was achieved when at least 75% of investigators agreed on each aspect of the study protocol. Only symptomatic ASF/SSF diagnosed by radiograph or computed tomography were considered. Multivariable logistic regression was performed to identify factors associated with ASF/SSF development. RESULTS We identified 6755 RSAs with an average follow-up of 19.8 months (range, 3-94). The total stress fracture incidence rate was 3.9% (n = 264), of which 3.0% (n = 200) were ASF and 0.9% (n = 64) were SSF. Fractures occurred at an average 8.2 months (0-64) following RSA with 21.2% (n = 56) following a trauma. Patient-related factors independently predictive of ASF were chronic dislocation (odds ratio [OR] 3.67, P = .04), massive rotator cuff tear without arthritis (OR 2.51, P < .01), rotator cuff arthropathy (OR 2.14, P < .01), self-reported osteoporosis (OR 2.21, P < .01), inflammatory arthritis (OR 2.18, P < .01), female sex (OR 1.51, P = .02), and older age (OR 1.02 per 1-year increase, P = .02). Factors independently associated with the development of SSF included osteoporosis (OR 2.63, P < .01), female sex (OR 2.34, P = .01), rotator cuff arthropathy (OR 2.12, P = .03), and inflammatory arthritis (OR 2.05, P = .03). CONCLUSION About 1 in 26 patients undergoing RSA will develop a symptomatic ASF or SSF, more frequently within the first year of surgery. Our results indicate that severe rotator cuff disease may play an important role in the occurrence of stress fractures following RSA. This information can be used to counsel patients about potential setbacks in recovery, especially among older women with suboptimal bone health. Strategies for prevention of ASF and SSF in these at-risk patients warrant further study. A follow-up study evaluating the impact of prosthetic factors on the incidence rates of ASF and SSF may prove highly valuable in the decision-making process.
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Affiliation(s)
| | - Kuhan A Mahendraraj
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA
| | - Joseph Abboud
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | | | - Luke Austin
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Tyler Brolin
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, Memphis, TN, USA
| | - Vahid Entezari
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Brian Grawe
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | - Paul-Anthony Hart
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA
| | - Rhett Hobgood
- Mississippi Sports Medicine and Orthopaedic Surgery, Jackson, MS, USA
| | | | - Joseph Iannotti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joseph King
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael A Kloby
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Margaret Knack
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, Memphis, TN, USA
| | - Jon Levy
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | - Anand Murthi
- MedStar Union Memorial Hospital, Baltimore, MD, USA
| | | | | | - Randall Otto
- St. Louis University Care Physician Group, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Douglas E Parsell
- Mississippi Sports Medicine and Orthopaedic Surgery, Jackson, MS, USA
| | - Teja Polisetty
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | | | - Eric Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Tashjian
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Thomas Throckmorton
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, Memphis, TN, USA
| | - Clay Townsend
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Thomas Wright
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Zachary Zimmer
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA.
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Seely KD, Kotelko CA, Douglas H, Bealer B, Brooks AE. The Human Gut Microbiota: A Key Mediator of Osteoporosis and Osteogenesis. Int J Mol Sci 2021; 22:9452. [PMID: 34502371 PMCID: PMC8431678 DOI: 10.3390/ijms22179452] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 12/14/2022] Open
Abstract
An expanding body of research asserts that the gut microbiota has a role in bone metabolism and the pathogenesis of osteoporosis. This review considers the human gut microbiota composition and its role in osteoclastogenesis and the bone healing process, specifically in the case of osteoporosis. Although the natural physiologic processes of bone healing and the pathogenesis of osteoporosis and bone disease are now relatively well known, recent literature suggests that a healthy microbiome is tied to bone homeostasis. Nevertheless, the mechanism underlying this connection is still somewhat enigmatic. Based on the literature, a relationship between the microbiome, osteoblasts, osteoclasts, and receptor activator of nuclear factor-kappa-Β ligand (RANKL) is contemplated and explored in this review. Studies have proposed various mechanisms of gut microbiome interaction with osteoclastogenesis and bone health, including micro-RNA, insulin-like growth factor 1, and immune system mediation. However, alterations to the gut microbiome secondary to pharmaceutical and surgical interventions cannot be discounted and are discussed in the context of clinical therapeutic consideration. The literature on probiotics and their mechanisms of action is examined in the context of bone healing. The known and hypothesized interactions of common osteoporosis drugs and the human gut microbiome are examined. Since dysbiosis in the gut microbiota can function as a biomarker of bone metabolic activity, it may also be a pharmacological and nutraceutical (i.e., pre- and probiotics) therapeutic target to promote bone homeostasis.
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Affiliation(s)
- Kevin D. Seely
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (C.A.K.); (H.D.); (B.B.); (A.E.B.)
| | - Cody A. Kotelko
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (C.A.K.); (H.D.); (B.B.); (A.E.B.)
| | - Hannah Douglas
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (C.A.K.); (H.D.); (B.B.); (A.E.B.)
| | - Brandon Bealer
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (C.A.K.); (H.D.); (B.B.); (A.E.B.)
| | - Amanda E. Brooks
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (C.A.K.); (H.D.); (B.B.); (A.E.B.)
- Department of Research and Scholarly Activity, Rocky Vista University, Ivins, UT 84738, USA
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23
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Cancienne JM, Dempsey IJ, Garrigues GE, Cole BJ, Brockmeier SF, Werner BC. Trends and impact of three-dimensional preoperative imaging for anatomic total shoulder arthroplasty. Shoulder Elbow 2021; 13:380-387. [PMID: 34394735 PMCID: PMC8355644 DOI: 10.1177/1758573220908865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/29/2019] [Accepted: 01/29/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The goals of this study were to determine the incidence in the United States of preoperative three-dimensional imaging prior to anatomic total shoulder arthroplasty for osteoarthritis and to determine if preoperative imaging is associated with decreased complication rates. METHODS Using a Medicare insurance database, we identified all patients who underwent computed tomography (n = 9380) and/or magnetic resonance imaging (n = 15,653) prior to anatomic total shoulder arthroplasty for a diagnosis of osteoarthritis from 2005 to 2014. The incidence of imaging over time was analyzed and complication rates compared between patients with imaging to matched controls. RESULTS The incidence of preoperative three-dimensional imaging significantly increased over time, with computed tomography increasing more than magnetic resonance imaging. Compared to controls, patients with preoperative computed tomography imaging had significantly lower revision rates at two years (odds ratio 0.72 (0.64-0.82), p = 0.008). There were no other significant differences in the other complications studied. CONCLUSIONS The use of preoperative three-dimensional imaging for anatomic total shoulder arthroplasty for a diagnosis of osteoarthritis has increased dramatically, with the use of computed tomography increasing the most. Patients who underwent preoperative computed tomography imaging experienced lower revision rates at two years postoperatively compared to matched controls without such imaging. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
| | - Ian J Dempsey
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, USA
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, USA
- Brian C Werner, Department of Orthopaedic
Surgery, University of Virginia Health System, PO Box 800159, Charlottesville,
VA, USA.
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24
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Godlewski M, Knudsen ML, Braman JP, Harrison AK. Perioperative Management in Reverse Total Shoulder Arthroplasty. Curr Rev Musculoskelet Med 2021; 14:282-290. [PMID: 34414560 PMCID: PMC8390714 DOI: 10.1007/s12178-021-09709-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW A successful reverse total shoulder arthroplasty requires careful preoperative planning and perioperative management. Preoperative comorbidity risks, perioperative pain management, and postoperative rehabilitation are all critical components of this arthroplasty. The current review examines available literature to guide the perioperative care of the reverse total shoulder arthroplasty patient. RECENT FINDINGS One of the most important advances for shoulder arthroplasty in recent years has been heightened awareness of various modalities for perioperative pain management. A number of recent studies have focused on the options for regional blockade as a critical tool for postoperative pain relief and the use of either continuous interscalene blocks or single shot blocks are supported. Additional studies are necessary to define the best local anesthetic agent and delivery mechanism to provide appropriate pain relief with a low side effect profile. Management of the patient throughout the perioperative course is a critical component in achieving better patient outcomes delivering high quality patient care. An orthopedic surgery team focused on perioperative management is better positioned to decrease adverse events and improve patient outcomes after reverse total shoulder arthroplasty.
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Affiliation(s)
- Matthew Godlewski
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MIN USA
| | - Michael L Knudsen
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MIN USA
| | - Jonathan P Braman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MIN USA
| | - Alicia K Harrison
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MIN USA
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25
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Moverman MA, Menendez ME, Mahendraraj KA, Polisetty T, Jawa A, Levy JC. Patient risk factors for acromial stress fractures after reverse shoulder arthroplasty: a multicenter study. J Shoulder Elbow Surg 2021; 30:1619-1625. [PMID: 33038496 DOI: 10.1016/j.jse.2020.09.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/07/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the growing recognition of acromial stress fractures (ASFs) after reverse total shoulder arthroplasty (RTSA), most of the current data are derived from single-center studies with limited generalizability. This multicenter study investigated the incidence of ASFs after RTSA and identified preoperative patient characteristics associated with their occurrence. METHODS Using 2 institutional registries from different regions of the United States, we identified 1479 patients undergoing either primary or revision RTSA between 2013 and 2018 with minimum 3-month follow-up. ASFs were defined as radiographic evidence of an acromial or scapular spine fracture with clinical symptoms (eg, tenderness over the acromion or scapular spine). Multivariable logistic regression was performed to identify preoperative patient factors associated with the development of ASFs. RESULTS Overall, 54 (3.7%) patients were diagnosed with an ASF after RTSA. Patient-related factors independently associated with the development of an ASF included female sex (odds ratio [OR], 2.21 reference: male; 95% confidence interval [CI], 1.03-4.74; P < .05), rheumatoid arthritis (OR, 2.30; 95% CI, 1.02-5.16; P < .05), osteoporosis (OR, 2.55; 95% CI, 1.24-5.21; P < .05), a diagnosis of degenerative joint disease with rotator cuff tear (OR, 4.74 reference: degenerative joint disease without rotator cuff tear; 95% CI, 1.84-12.23; P < .05), and fracture malunion/nonunion (OR, 5.21; 95% CI, 1.20-22.76; P < .05). CONCLUSIONS The non-negligible percentage of ASFs that occur after RTSA is associated with the diagnoses of rotator cuff dysfunction and chronic fracture sequelae in female patients with suboptimal bone health. This information can be used to counsel patients and set expectations about potential setbacks in recovery.
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Affiliation(s)
- Michael A Moverman
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA
| | - Kuhan A Mahendraraj
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA
| | - Teja Polisetty
- Department of Orthopaedics, Holy Cross Orthopaedic Institute, Fort Lauderdale, FL, USA
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA.
| | - Jonathan C Levy
- Department of Orthopaedics, Holy Cross Orthopaedic Institute, Fort Lauderdale, FL, USA
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Prevalence and Treatment of Osteoporosis Prior to Elective Shoulder Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00204. [PMID: 33986217 PMCID: PMC7722598 DOI: 10.5435/jaaosglobal-d-20-00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022]
Abstract
Introduction: The rate of preoperative osteoporosis in lower extremity arthroplasty is 33%. The prevalence of osteoporosis in shoulder arthroplasty patients is inadequately studied. The purpose of this study was to (1) determine the prevalence of osteoporosis in patients undergoing elective shoulder arthroplasty, (2) report the percentage of patients having dual-energy x-ray absorptiometry (DEXA) testing before surgery, and (3) determine the percentage of patients who have been prescribed osteoporosis medications within 6 months before or after surgery. Methods: This retrospective case series included all adults aged 50 years and older who underwent elective shoulder arthroplasty at a single tertiary care center over an 8-year period. National Osteoporosis Foundation (NOF) criteria for screening and treatment were applied. Results: Two hundred fifty-one patients met the inclusion criteria; 171 (68%) met the criteria for DEXA testing, but only 31 (12%) had this testing within 2 years preoperatively. Eighty patients (32%) met the NOF criteria for receipt of pharmacologic osteoporosis treatment, and 17/80 (21%) received a prescription for pharmacotherapy. Discussion: Two-thirds of elective shoulder arthroplasty patients meet the criteria to have bone mineral density measurement done, but less than 20% have this done. One in three elective shoulder arthroplasty patients meet the criteria to receive osteoporosis medications, but only 20% of these patients receive therapy.
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27
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Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review. INTERNATIONAL ORTHOPAEDICS 2020; 44:2673-2681. [PMID: 32995915 PMCID: PMC7679357 DOI: 10.1007/s00264-020-04813-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 09/15/2020] [Indexed: 12/25/2022]
Abstract
Purpose Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature. Methods We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group. Results Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four non-traumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor. Conclusions Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality.
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28
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Yang Q, Wang J, Xu Y, Chen Y, Lian Q, Zhang Y. Incidence and risk factors of in-hospital prosthesis-related complications following total hip arthroplasty: a retrospective Nationwide Inpatient Sample database study. INTERNATIONAL ORTHOPAEDICS 2020; 44:2243-2252. [DOI: 10.1007/s00264-020-04682-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022]
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29
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Brusalis CM, Taylor SA. Periprosthetic Fractures in Reverse Total Shoulder Arthroplasty: Current Concepts and Advances in Management. Curr Rev Musculoskelet Med 2020; 13:509-519. [PMID: 32506260 DOI: 10.1007/s12178-020-09654-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Expanded indications for reverse total shoulder arthroplasty (RSA) have raised awareness of associated complications, including periprosthetic fractures. The purpose of this article was to provide a comprehensive update on how, when, and why RSA-related periprosthetic fractures occur, as well as to describe the current treatment strategies. RECENT FINDINGS Periprosthetic acromial and scapular spine fractures occur in up to 4.3% of cases and periprosthetic humeral fractures occur in approximately 3.5% of RSA procedures. Fractures of the coracoid process and clavicle have also been reported. Current literature has identified several risk factors for intraoperative or postoperative fracture, including underlying osteoporosis, revision arthroplasty, use of a superiorly placed screw during metaglene fixation, and disruption of the scapular ring by transection of the coracoacromial ligament. Periprosthetic fracture associated with RSA is a clinically significant event that warrants prolonged postoperative vigilance, timely diagnosis, and shared patient decision-making regarding treatment. Further research is needed to identify optimal treatment strategies and characterize long-term clinical outcomes following RSA-related periprosthetic fracture.
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Affiliation(s)
| | - Samuel A Taylor
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. .,Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA.
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