搜索结果：Arthroplasty

Proximal humeral fractures (PHF) are common in the elderly population, and the use of reverse total shoulder arthroplasty (rTSA) as treatment has risen substantially in recent years. As opposed to statistical significance, clinical value has increasingly been utilized to evaluate outcomes, thus this study aims to define patient acceptable symptom state (PASS) thresholds, minimal clinically important differences (MCID), and substantial clinical benefit (SCB) values for American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score (CMS), and Shoulder Arthroplasty Smart (SAS) score in patients undergoing rTSA for PHFs. A prospectively collected multicenter database inclusive of 43 clinical sites using Advita Ortho implant system was queried for patients receiving who underwent reverse total shoulder arthroplasty for proximal humeral fracture with a minimum of 2 years follow-up between 2007 and 2024. Patients were divided into Early (no prior ORIF, malunion, or nonunion) and Late (history of ORIF, malunion, or nonunion) treatment groups. Prospectively, outcome metrics including preoperative and postoperative CMS, ASES score, SAS score, active range of motion, visual analog scale (VAS) pain scores, self-reported shoulder function score, and patient satisfaction rate were collected from the electronic medical record. Receiver operating characteristic (ROC) curve analysis was used to determine the PASS thresholds while MCID and SCB values were determined via anchor-based methods and distribution-based methods, respectively. PASS thresholds were numerically higher in the Late group across all measures. Postoperative ASES, CMS, and SAS scores all showed good discriminative ability for identifying patients who achieved PASS. Optimal PASS thresholds were 58 (AUC = 0.73) and 60 (AUC = 0.80) for ASES, 62 (AUC = 0.65) and 66 (AUC = 0.77) for CMS, and 61 (AUC = 0.74) and 67. (AUC = 0.85) for SAS in the Early and Late groups, respectively. Anchor-based MCID values were slightly lower in the Late group, suggesting that a smaller score change was needed for perceived improvement by patients (ASES: 10.84 and 10.31; CMS: 9.59 and 8.54; SAS: 10.75 and 7.60). Distribution-based SCB thresholds were observed to have higher values in the Early group, indicating that patients treated earlier required greater functional improvement to perceive substantial benefit (ASES: 17.35 and 16.49; CMS: 15.35 and 13.67; SAS: 17.19 and 12.16). In patients undergoing reverse total shoulder arthroplasty for proximal humeral fracture, PASS thresholds for ASES, CMS, and SAS demonstrate good discriminative ability for identifying clinically meaningful improvement. Thresholds are reported separately for Early and Late treatment cohorts and should be interpreted as descriptive benchmarks.

Periprosthetic femoral fractures (PFFs) following bipolar hemiarthroplasty (BHA) are a serious complication in frail elderly patients. Revision arthroplasty is generally recommended for Vancouver B2 fractures with stem loosening, but it is associated with high perioperative risks. Open reduction and internal fixation (ORIF) has emerged as a less invasive alternative, but its efficacy remains controversial. This multicenter study compared the clinical outcomes of ORIF and revision arthroplasty for Vancouver B2 PFFs after BHA. We retrospectively reviewed data from the Trauma Research Group (TRON) registry, encompassing 16 tertiary trauma centers in Central Japan. Between 2010 and 2023, 59 patients with Vancouver B2 fractures following BHA for femoral neck fractures were included: 23 underwent ORIF and 36 received revision arthroplasty. Baseline characteristics, perioperative parameters, postoperative complications, reoperation rates, stem subsidence, RUST score, mortality, and functional outcomes were compared between groups. Functional recovery was evaluated using the Parker Mobility Score (PMS) and the Merle d'Aubigné score. Survival was analyzed using Kaplan-Meier estimates and compared with the log-rank test. The mean age was 81 years, and baseline demographics were similar between groups. Mean operative time and intraoperative blood loss were significantly lower in the ORIF group than in the revision group (153 vs. 207 min, p = 0.021; 340 vs. 752 mL, p = 0.004). No significant differences were found in postoperative complications, reoperation rates (ORIF 13%, revision 8%; p = 0.669), or one-year mortality (approximately 30% in both groups, log-rank p = 0.79). Functional and radiographic outcomes were also comparable between groups. For Vancouver B2 PFFs after BHA, ORIF was associated with outcomes comparable to revision arthroplasty while significantly reducing operative time and blood loss. ORIF may be an alternative option in selected high-risk patients, and treatment decisions should be individualized.

The aim of this study was to investigate the impact of musculoskeletal (MSK) health literacy on clinical outcomes and patient satisfaction following total shoulder arthroplasty (TSA). We hypothesized that low MSK health literacy score would be associated with inferior clinical outcomes and lower patient satisfaction rates. A retrospective cohort study was conducted at a tertiary care center. Patients between 6 months and 9 years post-operative following shoulder arthroplasty, both anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty were included. All patients were treated by one of 2 sports fellowship-trained surgeons. Patients were emailed a questionnaire that included basic demographics, American Shoulder and Elbow Surgeons (ASES) shoulder score, TSA satisfaction, and the Literacy in Musculoskeletal Problems survey. Patients were categorized as having low health literacy (LHL) if they answered fewer than 6 out of 9 questions correctly on the Literacy in Musculoskeletal Problems survey and as having normal health literacy (NHL) if they answered 6 or more questions correctly. Statistical analysis was performed to determine associations between LHL, patient characteristics, and outcomes of interest. This included multivariate logistic and linear regression models that assessed the relationship between MSK health literacy and ASES. Of 734 patients emailed the survey, 310 responded, and 230 met inclusion criteria and were included in the final analysis. One hundred and seventy-seven patients (77%) had NHL and 53 individuals (23%) had LHL. The mean ASES score was 74.2 ± 19.8 in the NHL group and 62.9 ± 23.9 in the LHL group. Patients with LHL had significantly lower ASES scores than those with NHL (P = .0007). Patient satisfaction rate (90.3% vs. 82.7%, P = .2101) and willingness to undergo surgery again (89.8% vs. 84.9%, P = .334) were similar between the NHL and LHL groups, respectively. Multivariate analysis showed that NHL was independently predictive of a significantly higher ASES score (P = .009, odds ratio: 1.025). Approximately one-quarter of patients undergoing TSA at our institution had LHL. Patients with LHL were found to have significantly lower patient-reported outcome scores, although rates of patient satisfaction and willingness to undergo surgery again were comparable to those with NHL. These findings highlight an association between health literacy and post-operative recovery that likely reflects the influence of broader educational and socioeconomic determinants of health. These findings should be interpreted as associative and hypothesis-generating.

Revision total elbow arthroplasty is technically demanding and carries a substantial risk of postoperative neurological complications because of scarring, altered anatomy, implant removal, and repeated humeral and ulnar exposure. The incidence, nerve distribution, and recovery profile of nerve injury after revision total elbow arthroplasty remain incompletely defined. This study aimed to systematically review the literature to define the incidence, recovery profile, and risk factors for nerve injury after revision TEA. A systematic review of the literature was performed in accordance with PRISMA guidance. Thirteen retrospective case series were included, comprising 282 revision total elbow arthroplasties in 271 patients. Random-effects meta-analysis of proportions was undertaken where the data permitted. The primary outcome was postoperative nerve injury following revision total elbow arthroplasty. Secondary outcomes included nerve type, recovery, secondary nerve-related procedures, infection, triceps insufficiency, metallosis, periprosthetic fracture, and re-revision. The pooled incidence of postoperative nerve injury was 22.3% (95% CI 16.3 to 29.6; I2 = 34.6%). The crude incidence was 60 of 282 revisions (21.3%, 95% CI 16.6 to 26.5). The ulnar nerve was involved in 66.7% of all nerve injuries, the radial nerve in 31.7%, and the median nerve in 1.7%. No significant difference in pooled nerve-injury incidence was identified between studies published before 2010 and those published from 2010 onwards (22.9% vs 21.4%, p = 0.837). Recovery reporting was heterogeneous; among injuries with numerically extractable outcomes, 85.4% improved partially or completely (95% CI 72.2 to 93.9). Secondary nerve-related procedures were reported in seven studies. Pooled complication estimates were 10.2% for infection, 13.6% for triceps insufficiency, 25.5% for metallosis, 15.9% for periprosthetic fracture, and 14.0% for re-revision. Postoperative nerve injury is a common and clinically important complication of revision total elbow arthroplasty, affecting approximately one in five cases. The ulnar nerve is most frequently involved, although radial nerve injury accounts for a substantial proportion of cases. Many neuropathies improve during follow-up, but persistent deficits and the need for secondary nerve-related procedures are not uncommon. Future studies should adopt standardised neurological definitions and reporting to improve comparability and guide preventive surgical strategies.

Shoulder arthroplasty has emerged as a reliable treatment for end-stage glenohumeral arthritis. However, as the volume of total shoulder arthroplasty (TSA) increases nationwide, revision procedures are expected to rise in parallel. These surgeries are already known to be technically challenging and associated with higher complication rates, longer recovery, and increased costs. Despite this growing demand, limited large-scale data exist to identify which patient factors predict early failure and adverse outcomes. This study aimed to evaluate predictors of revision and postoperative complications following TSA using a national health system database to guide preoperative optimization and surgical planning. A retrospective cohort study was performed using the Hospital Corporation of America (HCA) Healthcare database to identify adults (&#x2265;18 years) who underwent primary or revision TSA between 2016 and 2022. Variables included patient demographics (age, sex, race, BMI), and Elixhauser Comorbidity Index (ECI). The primary outcomes were revision within 2 years and incidence of postoperative complications (including infections, cardiac events, thromboembolic events, and prosthetic complications). Secondary outcomes included time to revision and length of hospital stay. Multivariable logistic regression was used to assess predictors of revision and complications, while linear regression evaluated associations with timing of revision. Among 44,952 TSA cases, 579 patients (1.3%) underwent revision within two years. Male sex (OR 1.77; 95% CI 1.50-2.10; p<0.001) and higher ECI (OR 1.09, 95% CI 1.03-1.14, p=0.001) were significantly associated with increased revision risk. Increasing age was associated with a 2% decrease in odds per additional year of age (OR 0.98; 95% CI 0.97-0.99; p<0.001). Postoperative complications occurred in 1,413 patients (3.1%) and were more common among younger patients (OR 0.98 per year; p<0.001), males (OR 1.52; p<0.001), and those with higher comorbidity burden (OR 1.12 per unit; p<0.001). Race and BMI were not significantly associated with revision or postoperative complications. Among patients who underwent revision, the mean time to revision was 205 days, and no patient-level variables were significantly associated with time to revision on multivariable analysis. This large-scale analysis identifies male sex, younger age, and higher comorbidity burden as independent factors associated with revision surgery and postoperative complications following total shoulder arthroplasty. These findings highlight the need for risk-informed patient selection, counseling, and perioperative optimization. As the volume of total shoulder arthroplasty continues to grow, these results support the development of targeted care pathways aimed at minimizing revision rates and improving outcomes across diverse patient populations.

Outpatient total shoulder arthroplasty (TSA) is increasingly performed as perioperative pathways and value-based care models expand. However, a subset of patients scheduled for outpatient TSA require unexpected inpatient admission, which may indicate higher perioperative risk and increased resource use. We hypothesized that older age, greater comorbidity burden, and longer operative time would be associated with conversion from planned outpatient TSA to inpatient admission, and that conversion would be associated with worse short-term outcomes. Planned outpatient TSA cases were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2021. Revision arthroplasty, hemiarthroplasty, procedures for infection or malignancy, fracture-related cases, emergency or other nonelective cases, records with missing length of stay (LOS), and extreme LOS outliers were excluded. All included cases were planned outpatient procedures; patients with LOS 0-1 day comprised the Outpatient cohort, and those with LOS &#x2265;2 days comprised the Conversion-to-Inpatient cohort. Demographics, comorbidities, operative time, and 30-day outcomes were compared between groups, and multivariable logistic regression identified independent predictors of conversion and associations with adverse events. A total of 6,755 planned outpatient TSA cases met inclusion criteria, including 6,302 (93.3%) Outpatient and 453 (7.2%) Conversion-to-Inpatient cases. Compared with Outpatient patients, the Conversion-to-Inpatient cohort was older (70.3 &#xb1; 9.6 vs 68.0 &#xb1; 9.5 years), more often female, and more frequently Hispanic, with higher BMI and a greater proportion of American Society of Anesthesiologists class &#x2265;3 and comorbidities (all P < .05). Mean operative time was longer among converted patients (127.9 &#xb1; 59.3 vs 104.7 &#xb1; 40.8 minutes, P < .001). On multivariable analysis, older age, female sex, Hispanic ethnicity, ASA &#x2265;3, diabetes, COPD, and longer operative time were independent predictors of conversion. Conversion-to-Inpatient status was associated with higher odds of 30-day reoperation, overall morbidity, bleeding transfusion, and non-home discharge, while adjusted 30-day readmission did not differ significantly between cohorts. Unplanned conversion from outpatient to inpatient status occurs in approximately 7% of planned outpatient TSAs and is associated with identifiable demographic, comorbidity, and operative risk factors, as well as higher morbidity, transfusion requirements, and non-home discharge. These findings may help inform patient counseling and perioperative planning for outpatient TSA pathways.

Periprosthetic joint infection (PJI) remains a devastating complication following total joint arthroplasty, leading to substantial morbidity and increased healthcare costs. Cefazolin is the standard agent for perioperative antibiotic prophylaxis. However, the rising prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has prompted the use of dual prophylaxis with vancomycin and cefazolin. The efficacy and safety of this combined strategy remain controversial. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered on the international prospective register of systematic reviews (ID CRD420251077695). A comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library was performed. Randomized controlled trials and observational studies directly comparing cefazolin alone with combined vancomycin and cefazolin as intravenous prophylaxis in patients undergoing total joint arthroplasty were included. The primary outcome measures were PJI and SSI (surgical site infection), and secondary outcome measures were AKI (acute kidney injury). Eight studies including 1,041,058 patients met the inclusion criteria. Dual prophylaxis was associated with a higher risk of SSI (odds ratio [OR] =1.39; 95% confidence interval [CI] = 1.23 to 1.58), but a lower risk of PJI (OR = 0.64; 95% CI = 0.46 to 0.91). There was no significant difference in risk of AKI between regimens (OR = 1.30; 95% CI = 0.76 to 2.20), although substantial heterogeneity was observed among studies reporting renal outcomes. Routine addition of vancomycin to cefazolin does not reduce overall SSI rates and may increase superficial infections. However, it may decrease PJI risk without significantly increasing AKI. These findings support a selective, risk-stratified prophylactic strategy rather than universal dual antibiotic therapy in total joint arthroplasty.

Social determinants of health influence patient outcomes. In total joint arthroplasty (TJA), factors such as race, marital status, insurance type, and socioeconomic status affect outcomes and discharge disposition. One underexplored factor is patient education level. Although census data associate higher education with improved health outcomes, its impact following TJA has not been examined. This study evaluated differences in outcomes and discharge disposition between patients with higher versus lower education levels after TJA. A retrospective review within an integrated healthcare system identified consecutive patients undergoing primary TJA from 2011 to 2021 using CPT codes 27130 (total hip arthroplasty [THA]) and 27447 (total knee arthroplasty [TKA]). Patients were grouped by education level: greater than high school (GHS) and less than or equal to high school (LHS), as documented in the medical record. Demographics, comorbidities, surgical variables, and 90-day postoperative complications were analyzed. A total of 887 patients met inclusion criteria (451 GHS, 436 LHS) with mean follow-up of 6.7&#xa0;&#xb1;&#xa0;3.0 years. GHS patients were younger (63.8&#xa0;&#xb1;&#xa0;11.1 vs. 65.6&#xa0;&#xb1;&#xa0;12.0 years, p&#xa0;=&#xa0;0.022) and less likely to undergo TKA (59% vs. 68%, p&#xa0;=&#xa0;0.005). Groups were similar in race, body mass index, Charlson comorbidity index, smoking status, and insurance type. A greater proportion of GHS patients were discharged home (86% vs. 77%, p&#xa0;=&#xa0;0.002). Among TKA patients, home discharge remained higher in GHS patients (85% vs. 75%, p&#xa0;=&#xa0;0.019), with a similar trend in THA. There were no differences in length of stay, 90-day emergency department visits, readmissions, reoperations, or mortality. Patients with greater than high school education were more likely to be discharged home following TJA, particularly TKA. Education level may help identify at-risk patients undergoing TJA and anticipate postoperative resource needs.

Metal implant hypersensitivity remains a subject of ongoing debate in the orthopaedic community. With the global rise in total knee arthroplasty (TKA) procedures per annum and an increasing prevalence of reported metal allergies in the general population, understanding the clinical relevance of metal implant hypersensitivity in knee arthroplasty patients is essential. This systematic review evaluates the relationship between metal hypersensitivity, diagnostic testing, and postoperative outcomes following TKA. A literature search was conducted using the Ovid, MEDLINE, and Embase databases for studies published between 1990 and December 2024. Studies assessing diagnosis, management, or outcomes of metal hypersensitivity in TKA were included. Both prospective and retrospective studies were considered. The search yielded 554 records, with an additional 25 studies identified through manual reference screening. Following full-text assessment of 58 articles and application of predefined inclusion and exclusion criteria, 24 studies were included. Data extraction focused on study design, patient demographics, implicated metals, diagnostic methods, interventions, and outcomes. Patient Reporting Items for Systematic Reviews & Meta Analysis (PRISMA) guidelines were followed. A pooled cohort of 5615 knee arthroplasty cases was analyzed, with a mean patient age of 65.35 years and a female predominance (60.55%). Among these, 1165 patients had a documented history of metal hypersensitivity. Twenty studies reported follow-up durations, with a mean follow-up of 27.59 months. Patient symptoms, diagnostic test results, patient-reported outcome measures, and revision rates were evaluated. The available literature demonstrates significant heterogeneity and limited comparability across studies. Current evidence suggests that self-reported metal allergy or positive skin patch/lymphocyte transformation tests do not reliably predict poorer pain or functional outcomes following TKA. The clinical significance of metal hypersensitivity remains uncertain, highlighting the need for standardized diagnostic criteria and further high-quality research.

Cemented femoral fixation is recommended for arthroplasty in femoral neck fracture (FNF) because of lower periprosthetic fracture risk, but carries cement-related risks, longer operative time, and technical variability. Modern collared cementless stems have emerged as potential alternatives. This study compared a triple-tapered collared cementless stem with a collared composite-beam cemented stem in total hip arthroplasty (THA) for displaced FNF. We asked the following: (1) Is periprosthetic fracture risk different between fixation strategies?; (2) Are revision rates and survivorship different?; (3) Are functional outcomes comparable?; and (4) Are mortality and complications affected by fixation type? We retrospectively reviewed 521 primary THAs for displaced FNF (2017 to 2024) at a tertiary center. Patients received a cemented collared composite-beam stem (n = 105) or a triple-tapered collared cementless stem (n = 416). Primary outcomes were periprosthetic femoral fracture and all-cause revision. The secondary outcomes included intraoperative fracture, wound debridement, aseptic loosening, periprosthetic joint infection, stem subsidence greater than five mm, dislocation, venous thromboembolism, mortality, and Harris Hip Score (HHS). Propensity score overlap-weighting balanced baseline covariates. Survivorship was assessed with Kaplan-Meier and an overlap-weighted Cox model. Outcomes were reanalyzed in the Dorr C subgroup. After overlap-weighting, baseline covariates were well balanced. Weighted periprosthetic fracture (2.74 versus 2.97%) and all-cause revision (2.76 versus 5.36%) were comparable. Revision-free survivorship through 24 months did not differ (hazard ratio 0.896; P = 0.916). There were no dislocations. HHS favored cementless fixation (mean difference 6.50 points; P < 0.0001). Mortality was low and similar between groups. Dorr C subgroup findings were consistent with the cohort. After propensity score overlap-weighting, periprosthetic fracture rates, revision rates, and 24-month revision-free survivorship were comparable between a triple-tapered collared cementless stem and a collared composite-beam cemented stem in displaced FNF THA. The HHS was higher in the cementless group. Modern collared cementless stems may represent a reasonable option in select patients. Larger multicenter prospective studies with longer follow-up are needed to confirm durability and refine patient selection.

A 62-year-old man presented with bilateral posterior shoulder dislocations 2 months after sustaining an accidental electric shock while fishing. Imaging confirmed chronic locked posterior dislocations with reverse Hill-Sachs lesions and large humeral head articular defects (approximately 60% on the left and 55% on the right), together with partial-thickness supraspinatus and subscapularis tendon tears. The patient underwent staged reverse total shoulder arthroplasty. At the 12-month follow-up, he was free from pain with a markedly improved active range of motion (forward flexion, 130&#xb0;; abduction, 100&#xb0;) and excellent functional outcomes (constant score: 86, left shoulder; 83, right shoulder; ASES, 90). This case supports reverse shoulder arthroplasty as a viable option for a chronic bilateral posterior shoulder dislocation with substantial humeral head defects.

The utility and optimal threshold for serum laboratory tests taken prior to revision shoulder arthroplasty are unknown. We performed a multi-institutional study of consecutive revision shoulder arthroplasties to define the optimal thresholds of serum laboratory samples to predict bacterial presence in intraoperative cultures with and without Definite Periprosthetic Joint Infection (PJI). Multicenter data was collected on 579 revision shoulder arthroplasties. Preoperative serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complete blood count differentials, and ratios were reported. Analysis was stratified based on International Consensus Meeting (ICM) Definite and Non-Definite PJI and two different thresholds of culture positivity (&#x2265;2 or &#x2265;3). Receiver operating characteristic (ROC) curves were constructed, and area under the curve (AUC), optimal thresholds, and diagnostic utility for each test were calculated. Eighty-three patients (14%) had Definite PJI per ICM criteria while 496 (86%) had Non-Definite PJI. Cutibacterium was the most common bacteria recovered in both Definite PJI and Non-Definite PJI. For Definite PJI using a threshold of &#x2265;3 positive cultures, AUC values were 0.543 for ESR and 0.659 for CRP. Optimal thresholds based on ROC curves were 50.5 mm/hr for ESR and 5.9 mg/L for CRP. Sensitivity and specificity were 0.422 and 0.714, respectively, for ESR and 0.818 and 0.536, respectively, for CRP. For Non-Definite PJI, the AUC value was below 0.5 for ESR indicating the test was worse than chance. AUC values for CRP were 0.533 and 0.540 using thresholds of &#x2265;2 and &#x2265;3 positive cultures, respectively. Optimal threshold based on ROC curves were 9.1. This is the first large-scale, multicenter study of consecutive revision shoulder arthroplasties analyzing the utility of preoperative serum laboratory values in predicting positive intraoperative cultures. Overall diagnostic utility of these tests in predicting bacterial presence is low in the setting of both Definite and Non-Definite PJI, particularly serum ESR. In approaching patients with more obvious clinical symptoms (Definite PJI), optimal cutoff values are 50 mm/hr for ESR and 10 mg/L for CRP. When approaching workup of a patient without obvious signs of infection (Non-Definite PJI), serum ESR and CRP have limited value in predicting presence of bacteria at the time of revision arthroplasty.

Lateralized reverse total shoulder arthroplasty (rTSA) designs aim to restore tension and function of the deltoid and remaining rotator cuff. Although the role of the subscapularis (SSC) is established in the native shoulder and after anatomic total shoulder arthroplasty, its repair after rTSA remains controversial. The teres minor (TM) is considered a principal contributor to external rotation in rTSA, particularly when the infraspinatus (ISP) is insufficient, yet its length-tension behavior across forward elevation has not been characterized. Fifteen preoperative computed tomography scans from patients undergoing rTSA were used to generate three-dimensional shoulder models. rTSA was simulated using 4 lateralized implant configurations differing in glenoid baseplate position and neck-shaft angle (NSA): (1) a Frankle-type configuration with a centrally positioned ("high") glenoid baseplate and a 135&#xb0; NSA; (2) an inferiorly positioned (flush with the lower border of the glenoid) baseplate with a 135&#xb0; NSA; (3) an inferiorly positioned baseplate with a 145&#xb0; NSA; and (4) an inferiorly positioned baseplate with a 155&#xb0; NSA. Forward elevation from 0&#xb0; to 120&#xb0; at 20&#xb0; abduction and 0&#xb0; rotation was analyzed. Muscle-tendon length changes were computed for TM, SSC, ISP, and deltoid. Outcomes included biphasic prevalence, circle angle (the forward-elevation angle at which muscle length transitions from shortening to lengthening), and curvature. SSC consistently lengthened with forward elevation across all 4 lateralized rTSA designs. All TM curves (60/60, 100%) were biphasic, with early shortening followed by lengthening. The median TM circle angle occurred at 50&#xb0; [44-56] and curvature was -0.015 (95% confidence interval -0.016 to -0.015). In comparison, ISP was biphasic in 80% (48/60), SSC in 45% (27/60), and deltoid in 38% (23/60). Median circle angles were 77&#xb0; [71-83] for ISP, 38&#xb0; [25-52] for SSC, and 33&#xb0; [23-45] for deltoid. TM exhibited a significantly earlier circle angle than ISP (-26.9&#xb0;, 95% confidence interval -32.2 to -21.7) and greater curvature than all other muscles. These patterns were preserved across 135&#xb0;, 145&#xb0;, and 155&#xb0; designs. This study confirms SSC lengthening during forward elevation across lateralized rTSA designs and describes a novel biphasic length-tension pattern of the TM circle. These findings provide a biomechanical rationale for SSC repair vulnerability and highlight the functional contribution of the TM to external rotation in elevated positions after rTSA.

Current classifications used for total knee arthroplasty (TKA) are static and fail to capture the dynamic behavior of the limb during gait. This study introduces a novel intraoperative method to measure dynamic hip-knee angle (dHKA) using an intra-articular device coupled with a computer-assisted orthopaedic surgery (CAOS) system. This device applies a quasi-constant distraction force throughout the knee joint range of motion. A machine learning (ML) model was utilized to identify natural data groupings and develop a classification based on patient-specific dHKA profiles. We analyzed dHKA before and after the femoral cut (tibia-first TKA workflow) and assessed how often post-cut clusters matched pre-cut clusters across surgeons. A total of 1,890 tibia-first TKA cases performed by 11 surgeons were reviewed. For each case, HKA angles were recorded at 12 flexion angles (0 to 120&#xb0;) before and after the femoral cut. Using pre-cut data, a 12-dimensional map was created with each dimension representing the degree of HKA at a specific flexion angle. A K-means clustering model was trained on data collected before the tibial cut to identify alignment profiles. The trained model was then applied to data collected after the tibial cut for comparison. A subset of 141 TKA cases from a single surgeon who had one-year Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS Jr.) scores was analyzed to explore the association between cluster preservation and early functional outcomes. Clustering evaluation identified four clusters and an 8-dimensional feature space as optimal. Pre-cut/post-cut cluster distributions were cluster one (15.3%/14.2%), cluster two (35.9%/30.1%), cluster three (34.2%/35.6%), and cluster four (14.5%/20.2%). Cluster one was characterized as valgus and neutral, cluster two as neutral, cluster three as low to moderate varus, and cluster four as moderate to high varus. Overall, 69.4% of the cases retained the same cluster post-cut, with surgeon-specific match rates ranging from 61 to 88%. In the outcomes subset, 72.3% preserved their pre-cut cluster. Preservation was associated with greater KOOS Jr. improvement, with cluster-specific significance observed in low-to-moderate varus knees. This study demonstrates the first use of unsupervised ML to classify intraoperative dHKA profiles captured with a force-controlled intra-articular device and CAOS system. This enables real-time feedback and offers a foundation for an automated alignment classification guidance in personalized TKA.

Presently, there is no quantifiable and objective criteria for defining severe glenoid bone loss (GBL) for primary reverse total shoulder arthroplasty (rTSA). In this study, we sought to establish quantifiable thresholds of severe GBL using scapular statistical shape models and intraoperative assessment. In addition, we compared outcomes of severe GBL against moderate and mild cases of GBL. A retrospective review of 57 primary rTSA cases that were determined intraoperatively to be severe GBL were identified. These were uploaded to pre-operative planning software for three-dimensional (3D) reconstruction. Cases were propensity matched at a 1:1 ratio to moderate and mild bone loss cases based on age, sex, and time to final follow-up (mean 53.5 months). Glenoid version, inclination, maximum erosion depth, and glenoid vault loss (GVL) were compared between groups. Receiver operating characteristic (ROC) curves were used to determine severe bone loss thresholds. Blinded raters were asked to determine bone loss severity based on radiographs, 2D computed tomographies, or 3D reconstructions. Two-year and final follow-up American Shoulder Elbow Surgeons and visual analog scale (VAS) pain and function were compared between groups. There was a higher proportion of rotator cuff disease in the mild and moderate bone loss groups when compared to severe bone loss. ROC curves resulted in minimum thresholds for severe GBL of 5.5 mm maximum erosion depth, 12.5% GVL, and 17.5&#xb0; of version (area under curve = 0.944, 0.924, 0.812, respectively). Discrimination was highest when combining 2 of the 3 measurements (Youden's J = 0.82). Interobserver reliability was highest when using 3D reconstructions (&#x199; = 0.726). The mild bone loss group performed worse on American Shoulder Elbow Surgeons, VAS pain, and VAS function scores at 2 years and final follow-up when compared to the severe bone loss group. In this study, we found that severe GBL in primary rTSA is defined as medialization of at least 5.5 mm, GVL of greater than 12.5%, and retroversion greater than 17.5&#xb0;. Discrimination of severe bone loss from less severe bone loss is best done with at least 2 of the 3 measurements. In addition, these measurements have substantial agreement when blindly assessed and are strongest when using 3D reconstructions. Severe GBL outcomes are similar to less severe bone loss at a mean of 53.5 months, though this is in part driven by less rotator cuff disease in patients with less severe bone loss.

A 54-year-old woman had recurrent knee locking symptoms 2 years after undergoing left, medial unicompartmental knee arthroplasty (UKA). At the meniscal repair surgery following UKA, there was anterior translation of the lateral meniscus with anterior and posterior popliteomeniscal fascicle tears. Although the primary lateral meniscal repair using the all-inside technique failed, the patient's symptoms were resolved after the revision meniscal repair using the inside-out technique. For the symptoms of lateral meniscal tear after UKA, meniscal repair should be considered to reduce lateral compartment osteoarthritis progression.

Diaphyseal-engaging stems are conventionally used in conversion total hip arthroplasty (cTHA) after prior intramedullary nailing (IMN) to bypass screw holes and previously instrumented metadiaphyses. However, it remains unclear if cementless metaphyseal or standard cemented stems can also provide satisfactory fixation in this scenario. This study compared the early outcomes of cTHA using three femoral stem designs: metaphyseal cementless, diaphyseal cementless, and standard cemented. A retrospective review of 80 patients who underwent cTHA after prior IMN at a single academic center from 2014 to 2024 was conducted. Patients received either a metaphyseal press-fit stem, a standard-length cemented stem, or a diaphyseal-engaging stem. The 90-day complications were recorded, including any reoperation, periprosthetic joint infection (PJI), periprosthetic femoral fracture, or dislocation. An "at-risk" subgroup analysis of stem tips that were within four centimeters proximal of the interlock hole was also conducted. Patients who received metaphyseal stems were younger (56 versus 77 versus 72 years, P < 0.001) and had lower Charlson Comorbidity Index (1.5 versus 4.0 versus 2.2, P = 0.019) scores compared to those who received cemented stems or diaphyseal stems. There were no significant differences in 90-day complication rates observed among the three stem groups (P = 0.10). Notably, no postoperative periprosthetic fractures occurred in any group (P = 1.000). There were no differences in reoperation (P = 0.232), PJI (P = 1.00), or dislocation (P = 0.61) rates between the three groups. The "at-risk" subgroup analysis of 15 patients demonstrated no significant differences among the three groups for any complication and, notably, had no postoperative periprosthetic fractures. Metaphyseal-engaging stems and standard cemented stems in cTHA after IMN demonstrated similar outcomes to diaphyseal stems and may be reasonable options in cTHA after IMN in select patients.

Cementless fixation is increasingly adopted in total knee arthroplasty (TKA). In parallel, robotic-assisted (RA) techniques have enabled personalized alignment strategies like functional knee positioning (FKP). However, evidence on survivorship for cementless robotic-assisted-TKA (RA-TKA) with FKP remains limited. This study evaluated revision risk and clinical outcomes after cementless RA-TKA with FKP at a minimum 2-year follow-up and explored whether tibial component varus alignment, age, sex, or body mass index (BMI) were associated with revisions. This retrospective single-center study included all consecutive cementless cruciate-retaining or substituting RA-TKAs with FKP between November 2017 and September 2023. In total, 356 patients (381 RA-TKAs) who had a mean age of 70 years (range, 39.3 to 87.1) were analyzed at a minimum 2-year follow-up. The median follow-up was 3.5 years (95% confidence interval, CI: 3.3 to 3.8), and the follow-up rate was 94.9%. Survivorship was assessed using Kaplan-Meier analysis. Differences in survivorship stratified by tibial component coronal alignment (greater than 3 versus 3&#xb0; or less varus), age greater than 75 years, sex, and BMI greater than 30 were evaluated using log-rank tests. The forgotten joint score-12 and a 5-level Likert satisfaction scale were collected at the last follow-up. Estimated survivorship at five years was 98.6% (95% CI: 97.4 to 99.8), with five revisions (four periprosthetic joint infections and one arthrofibrosis). There was no aseptic loosening that occurred. Tibial component varus greater than 3&#xb0; was present in 35.6% of cases. Survivorship did not differ significantly between knees with and without tibial varus greater than 3&#xb0;, nor for age greater than 75 years, sex, or BMI greater than 30 (P > 0.05). The mean forgotten joint score-12 and satisfaction were 85.2 (standard deviation 20.2) and 4.7 (standard deviation 0.7). Cementless RA-TKA with FKP demonstrated excellent survivorship and high patient satisfaction at a minimum 2-year follow-up, with no aseptic loosening that occurred. There was no association between tibial component varus, age, sex, or BMI and revision detected, supporting the safety of cementless fixation in personalized robotic alignment; however, the low number of revision events limits the ability to identify predictors of failure.

Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction, and anterior cervical discectomy and fusion (ACDF) is the gold standard treatment. Cervical disc arthroplasty (CDA) is a relatively novel, motion preserving alternative to ACDF. The aim of this study was to assess CDA versus ACDF in the surgical treatment of CSM at a 5-year follow-up. This study used the 14-site Spine CORe&#x2122; study group cervical module of the Quality Outcomes Database (QOD), which included 1085 patients. Baseline demographics, clinical variables, and surgical parameters were collected. Patient-reported outcome measures (PROMs) included the EQ-5D, Neck Disability Index (NDI), and numeric rating scale (NRS) for neck pain and arm pain. Of the 1085 patients, 22 patients who underwent CDA with baseline and 5-year follow-up PROMs data who met the inclusion/exclusion criteria were selected. Nearest-neighbor propensity score matching was performed using a 4:1 matching ratio. Five-year PROMs were compared between the CDA and ACDF groups using the 2-sample t-test for continuous variables. Multivariable linear regression was performed to identify predictors of 5-year myelopathy severity. There were 1085 patients in the 14-site Spine CORe&#x2122; study group's QOD cervical module; 110 matched patients were analyzed, including 22 who underwent CDA (mean age 47.73 years) and 88 who underwent ACDF (mean age 48.89 years). The subcohort had 100% of PROMs data (NDI, NRS, EQ-5D, and mJOA) at the 5-year follow-up. There were no significant differences for 1- and 2-level operations between the CDA and ACDF groups (p = 0.34). There were no significant differences in 5-year PROMs between the two groups. Patients improved in each PROM category in both treatment groups when comparing baseline with 5-year PROMs. While the rate of reoperation at 5 years was higher in the ACDF group compared with the CDA group, there was no statistically significant difference (17.0% vs 9.1%, p = 0.52). In appropriately selected patients with CSM, CDA can provide comparable outcomes to ACDF while preserving cervical motion.