Clinical outcomes after reverse shoulder arthroplasty in patients 60 years old and younger; Medium-term results

BACKGROUND: Reverse total shoulder arthroplasty (RTSA) has been well-described as a surgical solution to manage rotator cuff tear arthropathy in elderly, low demand paitents. As experience has increased along with improvements in technique and implant design, RTSA has become increasingly used to manage more varied pathologic conditions of the shoulder in younger, more active patients. This study evaluates outcomes in a consecutive series of patients aged 60 years old and younger after undergoing RTSA. METHODS: There were 94 shoulders in 89 patients enrolled. Mean age of the cohort was 54.8 (range 18-60 years). Surgical indications included rotator cuff tear arthropathy, irreparable rotator cuff tear without arthritis, glenohumeral arthritis with erosive glenoid deformity, inflammatory arthropathy, proximal humerus fracture nonunion/malunion and failed prior shoulder arthroplasty. Sixty-one shoulders (70%) had undergone at least one prior surgery. Of these, 6 shoulders (6% of total cohort) had a prior failed arthroplasty. Clinical outcomes (American Shoulder and Elbow Surgeons score, Western Ontario Osteoarthritis of the Shoulder index; visual analog scale pain), radiographic outcomes and complications were analyzed and assessed for correlation with patient demographic factors. RESULTS: The mean follow-up for this cohort was 4.9 years (range 2-12 years). Subjects experienced improvements in ASES score and pain ( CONCLUSION: With medium-term follow-up, RTSA is a reliable and predictable operation to manage various pathologic conditions in patients aged 60 years or less. Patients predictably experience significant improvements in pain and range of motion while assuming a modest complication risk. Long-term study is needed to understand potential for late complications or implant failure

Association between rotator cuff muscle size and glenoid deformity in primary glenohumeral osteoarthritis

BACKGROUND: Although glenoid morphology has been associated with fatty infiltration of the rotator cuff in arthritic shoulders, the association of rotator cuff muscle area with specific patterns of glenoid wear has not been studied. The purpose of our study was to assess the associations of glenoid deformity in primary glenohumeral osteoarthritis and rotator cuff muscle area. METHODS: A retrospective study of 370 computed tomographic (CT) scans of osteoarthritic shoulders was performed. Glenoid deformity according to the modified Walch classification was determined, and retroversion, inclination, and humeral-head subluxation were calculated using automated 3-dimensional software. Rotator cuff muscle area was measured on sagittal CT scan reconstructions. A ratio of the area of the posterior rotator cuff muscles to the subscapularis was calculated to approximate axial plane potential force imbalance. Univariate and multivariate analyses to determine associations with glenoid bone deformity and rotator cuff measurements were performed. RESULTS: Patient age and sex were significantly related to cuff muscle area across glenoid types. Multivariate analysis did not find significant differences in individual rotator cuff cross-sectional areas across glenoid types, with the exception of a larger supraspinatus area in Type-B2 glenoids compared with Type-A glenoids (odds ratio [OR], 1.5; p = 0.04). An increased ratio of the posterior cuff area to the subscapularis area was associated with increased odds of a Type-B2 deformity (OR, 1.3; p = 0.002). Similarly, an increase in this ratio was significantly associated with increased glenoid retroversion (beta = 0.92; p = 0.01) and humeral-head subluxation (beta = 1.48; p = 0.001). Within the Type-B glenoids, only posterior humeral subluxation was related to the ratio of the posterior cuff to the subscapularis (beta = 1.15; p = 0.001). CONCLUSIONS: Age and sex are significantly associated with cuff muscle area in arthritic shoulders. Asymmetric glenoid wear and humeral-head subluxation in osteoarthritis are associated with asymmetric atrophy within the rotator cuff transverse plane. Increased posterior rotator cuff muscle area compared with anterior rotator cuff muscle area is associated with greater posterior glenoid wear and subluxation. It is unclear if the results are causative or associative; further research is required to clarify the relationship. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence

The rate and predictors of healing of repaired lesser tuberosity osteotomy in reverse total shoulder arthroplasty

BACKGROUND: Evidence is building that a functional subscapularis improves function-specifically internal rotation tasks-following reverse total shoulder arthroplasty (rTSA). However, the optimal method for subscapularis repair during rTSA remains unknown with variable healing rates reported. This study aims to investigate the rate of and predictors for healing a lesser tuberosity osteotomy (LTO) following rTSA. METHODS: Following local institutional review board approval, patients with at least one-year follow-up for rTSA managed with an LTO and subsequent repair between March, 2017 and March, 2020 were retrospectively identified. Shoulders were selected for LTO repair based upon preoperative imaging and intraoperative assessment of subscapularis quality. All patients were implanted with a system consisting of a 150° or 155° (constrained) humeral neck-shaft angle and 2.5 to 4.5 millimeters (mm) of glenoid lateralization (Trabecular Metal Reverse Shoulder System; Zimmer Biomet, Warsaw, IN, USA). At a minimum of six months, radiographs were reviewed for an assessment of LTO healing by three independent reviewers. Healing was classified as displaced, fibrous union, or ossified union. For assessing predictors, the repair was considered intact if the LTO fragment was not displaced (fibrous union or ossified union). RESULTS: Sixty-five rTSA with LTO repair were performed in 64 patients. These patients had an average age of 67.2 years (range, 31-81) and 36 (55.4%; 36/65) were female. At an average follow-up of 15.2 months (range, 8-38), 50 cases (76.9%; 50/65) were classified as having an ossified union. The radiographic healing could not be assessed in a single case. Of the 14 cases without ossific union, 8 (12.3%; 8/65) were displaced and 6 (9.2%; 6/65) were classified as a fibrous union. In logistic regression, only combined humeral liner height predicted LTO displacement (odds ratio = 1.4 [95% confidence interval = 1.1-1.8]; CONCLUSION: This analysis demonstrates that radiographic healing of LTO repair is more favorable than published rates of healing after subscapularis tenotomy or peel in the setting of rTSA. Subscapularis management with LTO provides the ability to monitor repair integrity with plain radiographs and a predictable radiographic healing rate. The integrity of subscapularis repair may be influenced by the use of thicker humeral liners. Further investigation is needed to determine the functional impact of a healed subscapularis following rTSA

Factors Associated with the Success and Timing of Orthopaedic Surgery Resident Research Thesis Project Publication

Introduction:. Scholarship and research are important aspects of orthopaedic surgery training. Many orthopaedic surgery residency programs have developed dedicated research curricula, often culminating in a capstone thesis project with the intended goal of peer-reviewed publication. However, data on the success of these programs are scarce. The purpose of the current study was to determine the success rate and time to publication of resident research thesis projects at our own institution while evaluating factors associated with these outcomes. Methods:. Resident research thesis projects performed over the past 15 years were aggregated and reviewed. Additional data regarding the projects and former trainees who performed them were collected using public resources which included measures of current academic aptitude (i.e., H-index and number of publications) as well as project and publication characteristics. Cox and linear regression analyses were conducted to assess the relation between numerous predictor variables and the success and time to publication. All analyses were conducted at the 95% confidence interval (CI) level. Results:. Sixty-eight (n = 68; 83%) resident research thesis projects were published an average of 2,582.8 days, or roughly 7 years from the start of their residency training. Graduate adjusted H-index was associated with increased success and decreased time to publication (hazard ratio 1.183 [95% CI: 1.059-1.322], p = 0.003). A lower journal impact factor was associated with taking significantly shorter time to reach publication (F(1,66) = 7.839, p = 0.007; Β1 = 146.45, p = 0.007). Study type (clinical vs. laboratory), posttraining practice setting (academic vs. private), and whether the research topic was within the same area of the trainee's matched fellowship(s) did not predict publication success. Discussion/Conclusion:. Over the past 15 years, 83% of orthopaedic resident research thesis projects at our institution were published. A higher adjusted H-index was associated with greater completion and faster timing to publication. A lower journal impact factor was also associated with quicker publication. These data highlight the publication metrics of a formalized resident research program and identify factors associated with success and timing of publication