Outpatient Total Shoulder Replacement Procedures

The number of total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) procedures performed each year has continued to rise. While these procedures were historically done in the inpatient setting, many surgeons have migrated to performing TSA and RTSA in the outpatient setting. This can either involve sending patients home the same day from the hospital or performing these in an outpatient center. Specific protocols should be followed in regard to patient selection to minimize the risk of complications and readmission. Similarly, a team approach between the anesthesiologist and the surgeon is critical to ensure adequate pain control. Use of tranexamic acid (TXA), a preoperative nerve block as well as specific combinations of preoperative and postoperative medications are helpful in creating an optimal environment in which to perform the shoulder arthroplasty for the patient. When done well, TSA and RTSA can successfully be performed as an outpatient with a very high success rate and a low risk of complications

Feeding Elevated Levels of Corn Silage and MDGS in Finishing Diets

A finishing experiment evaluated substitution of corn silage and modified distillers grains with solubles (MDGS) in place of corn. The experimental arrangementwas a 2 X 2 + 1 factorial with diets containing 15 or 45% corn silage and 20 or 40% MDGS as well as a control containing 5% cornstalks and 40% MDGS. There were no interactions between corn silage and MDGS inclusion for carcass adjusted performance. As corn silage inclusion increased in the diet, there was a modest reduction in ADG and an increase in F:G. When MDGS inclusion was increased, ADG and F:G were improved. Cattle fed 40% MDGS with 15% corn silage instead of 5% cornstalks had 5% improved F:G

Does Prior Acromioplasty Increase the Incidence of Acromial Fracture Following Reverse Total Shoulder Arthroplasty? A Retrospective Matched Cohort Analysis

Introduction: Reverse total shoulder arthroplasty (RTSA) is an effective treatment option for multiple shoulder pathologies. Arthroscopic acromioplasty is a treatment for subacromial impingement. RTSA can place excess stress on the acromion. No studies have evaluated outcomes following RTSA among patients with prior acromioplasty. The purpose of this study was to report outcomes in patients following RTSA who have had a prior acromioplasty. The authors hypothesized patients with prior acromioplasty who undergo RTSA will have significant improvements in clinical outcomes with no increased risk of acromial fracture. Methods: Patients from a single institution who underwent RTSA with a history of acromioplasty from 2009 to 2017 with two-year follow up were identified. Clinical outcome scores were obtained using ASES, SST, VAS, and SANE surveys. X-rays and charts will be reviewed to determine if patients sustained anacromion fracture following RTSA. Patients will be matched to a cohort of patients who underwent RTSA without a prior acromioplasty.These groups will be compared to determine any differences in clinical outcome scores or number of postoperative acromial fractures. Results: 45 patients were included.Average outcomes scores were: ASES:70.7%, SST: 62.1%, VAS: 2.4, and a SANE: 60.6%. On average, active external rotation improved from 33.1° to 37.1° and forward elevation improved from 92.2° to 136.1°. Discussion: While data collection in the matched cohort remains ongoing to compare the outcomes of RTSA with prior acromioplasty to the outcomes of RTSA alone, initial data suggests history of acromioplasty does not negatively impact RTSA outcomes

Effects of increasing soybean hulls in finishing diets with wet or modified distillers grains plus solubles on performance and carcass characteristics of beef steers

Two experiments evaluated feeding soybean hulls (SBH) in finishing diets that contain distillers grains plus solubles on performance and carcass characteristics. Dietary concentrations of SBH were 0, 12.5, 25, and 37.5% of diet DM. In Exp. 1, 167 crossbred yearling steers (395 ± 22 kg of BW) were fed for 117 d in a randomized block design in which pelleted SBH replaced dry-rolled corn. All diets contained 25% modified distillers grains plus solubles, 15% corn silage, and 5% liquid supplement. As SBH concentration increased, DMI decreased linearly (P = 0.04). Gain and G:F decreased linearly (P \u3c 0.01) in response to increasing concentrations of SBH, which decreased relative energy value from 91 to 79% of corn. Hot carcass weight linearly decreased (P \u3c 0.01) by 24 kg as SBH increased. In Exp. 2, a randomized block design used 160 backgrounded steer calves (363 ± 16 kg of BW) in a 138-d finishing study with 0, 12.5, 25, or 37.5% SBH in the meal form. Basal ingredients consisted of a 1:1 ratio of high-moisture corn and dry-rolled corn, 40% wet distillers grains plus solubles, 8% sorghum silage, and 4% dry meal supplement. There was a tendency (P = 0.12) for a quadratic increase in ADG and G:F as dietary SBH increased, with numerically greatest ADG and G:F with 12.5% SBH. Feeding 12.5 to 25% SBH with 40% wet distillers grains plus solubles (Exp. 2) had little effect on performance but decreased ADG and G:F in diets with 25% modified distillers grains plus solubles (Exp. 1)

Reducing Particle Size Enhances Chemical Treatment in Finishing Diets

Three hundred-sixty calf-fed steers were fed either treated or untreated corn stover that was previously ground through a 1-in or 3–in screen. Treated stover diets improved ADG and F:G compared to untreated. Reducing particle size improved ADG and F:G but did not influence DMI. Compared to a control diet with 5% roughage and 15 percentage units more corn, diets with 20% treated corn stover had similar F:G, ADG, DMI, and carcass quality. Up to 15% additional corn can be replaced with treated corn stover when diets contain wet distillers grains, and may be further enhanced by reducing particle size before chemical treatment

Reducing Particle Size Enhances Chemical Treatment in Finishing Diets

Three hundred-sixty calf-fed steers were fed either treated or untreated corn stover that was previously ground through a 1-in or 3–in screen. Treated stover diets improved ADG and F:G compared to untreated. Reducing particle size improved ADG and F:G but did not influence DMI. Compared to a control diet with 5% roughage and 15 percentage units more corn, diets with 20% treated corn stover had similar F:G, ADG, DMI, and carcass quality. Up to 15% additional corn can be replaced with treated corn stover when diets contain wet distillers grains, and may be further enhanced by reducing particle size before chemical treatment

Energy Value of Wet Distillers Grains in High Forage Diets

One hundred sixty crossbred steers were used to determine the energy value of wet distillers grains in high forage diets. By design, steers had similar intakes and gains across treatments. Diets included either wet distillers grains (WDGS) or dry rolled corn, sorghum silage, grass hay and supplement (DRC). Diets were formulated to meet degradable intake protein and metabolizable protein requirements. The energy value of wet distillers grains was calculated using the National Research Council model (1996). In this study, wet distillers grains contained 130% of the energy of dry rolled corn when fed in forage-based diets

Economics of Distillers Grains Supplementation in a Forage System with Spayed Heifers

In a two-year study, spayed heifer calves were backgrounded on cornstalks with 2 lb or 5 lb wet distillers grains with solubles supplemented daily. During the summer, heifers grazed native range and received no summer supplementation or were supplemented with modified distillers grains with solubles at 0.6% BW daily. Heifers were finished on a common regimen, and an economic scenario was applied to each phase of production and overall. Supplementing more in winter increased profit, but summer supplementation did not impact overall profitability. Numerically, heifers not supplemented during the summer were more profitable than supplemented heifers

Economics of Distillers Grains Supplementation in a Forage System with Spayed Heifers

In a two-year study, spayed heifer calves were backgrounded on cornstalks with 2 lb or 5 lb wet distillers grains with solubles supplemented daily. During the summer, heifers grazed native range and received no summer supplementation or were supplemented with modified distillers grains with solubles at 0.6% BW daily. Heifers were finished on a common regimen, and an economic scenario was applied to each phase of production and overall. Supplementing more in winter increased profit, but summer supplementation did not impact overall profitability. Numerically, heifers not supplemented during the summer were more profitable than supplemented heifers

Does Prehabilitation Prior to Ulnar Collateral Ligament Surgery Affect Return to Sport Rate or Time in Baseball Players with Partial UCL Tears?

Those who suffer a partial thickness ulnar collateral ligament (UCL) tear often undergo a period of nonoperative management including physical therapy rehabilitation. This treatment is aimed at optimizing range of motion (ROM) and strengthening the supporting structures around the elbow to help offload the UCL. Unfortunately, some of these patients fail nonoperative management and require surgical intervention. This creates a unique set of patients who essentially underwent “prehabilitation” prior to their UCL surgery. Prehabilitation is considered a period of structured physical therapy rehabilitation aimed at strengthening structures surrounding an injured tendon or ligament, to allow for dissipation of stress away from the repaired structure after surgery. Prehabilitation has been studied extensively and implemented into the clinical practice of anterior cruciate ligament (ACL) rehabilitation, and is being studied for other injuries as well. However, the efficacy of prehabilitation for UCL surgical patients with partial thickness UCL tears has not been evaluated. This chart review: - determines if baseball players with partial UCL tears who completed at least 4 weeks of prehabilitation prior to surgery (Prehab) had better return to play (RTP) rates and quicker return to sport (RTS) time than players who attempted 0-3 weeks of physical therapy prior to UCL surgery (No Prehab) - compares revision, reoperation, and patient reported outcomes between Prehab and No Prehab player