Characteristics of Clinical Shoulder Research Over the Last Decade: A Review of Shoulder Articles in \u3cem\u3eThe Journal of Bone & Joint Surgery\u3c/em\u3e from 2004 to 2014

Background: The purpose of this study was to determine characteristics and trends in published shoulder research over the last decade in a leading orthopaedic journal. Methods: We examined all clinical shoulder articles published in The Journal of Bone & Joint Surgery from 2004 to 2014. The number of citations, authorship, academic degrees of the authors, country and institution of origin, topic, level of evidence, positive or nonpositive outcome, and inclusion of validated patient-reported outcome measures were assessed for each article. Results: Shoulder articles that included an author with an advanced research degree (MD [Doctor of Medicine] with a PhD [Doctor of Philosophy] or other advanced degree) increased during the study period (p = 0.047). Level-I, II, and III studies were more likely to have an author with an advanced research degree, and Level-IV studies were more likely to have MDs only (p = 0.03). Overall, there was great variability of outcome measures, with at least thirty-nine different validated or nonvalidated outcome measures reported. Conclusions: Over the last decade, there was an improvement in the level of evidence of shoulder articles published in The Journal of Bone & Joint Surgery that corresponds with recent emphasis on evidence-based medicine. A consensus is needed in shoulder research for more consistent application of validated patient-reported outcome measurement tools

Risk factors for periprosthetic infection after reverse shoulder arthroplasty.

BACKGROUND: Management of periprosthetic infection after reverse shoulder arthroplasty (RSA) remains a challenge. Whereas the infection rate after RSA has improved, more information would be helpful to identify patient risk factors for infection after RSA. The purpose of this study was to evaluate risk factors for infection after RSA. METHODS: We identified 301 primary RSAs with a minimum of 1-year follow-up in a prospectively collected shoulder arthroplasty registry. We performed bivariate and multivariable logistic regression analyses to assess the association between patient demographic and clinical characteristics (age, sex, smoking, diabetes, rheumatoid arthritis, body mass index, and history of prior failed hemiarthroplasty or total shoulder arthroplasty) and periprosthetic infection after RSA. RESULTS: There were 15 periprosthetic infections after RSA (5.0%). Patients with a history of RSA for failed arthroplasty (odds ratio, 5.75; 95% confidence interval, 2.01-16.43; P = .001) and patients younger than 65 years had an increased risk for development of an infection (odds ratio, 4.0; 95% confidence interval, 1.21-15.35; P = .021). History of smoking, diabetes, rheumatoid arthritis, or obesity did not contribute to an increased risk of infection after RSA. CONCLUSIONS: This is the first study evaluating risk factors for infection after RSA while controlling for confounding variables with multivariable analysis. The greatest risk factors for infection after RSA were history of a prior failed arthroplasty and age younger than 65 years. Patients with these clinical characteristics should be counseled preoperatively about the increased risk for development of infection after RSA

Radiographic comparison of pegged and keeled glenoid components using modern cementing techniques: A prospective randomized study

Background: Modern cementing techniques have improved glenoid fixation, reduced glenoid lucency seen with keeled components, and may eliminate differences attributable to glenoid design. The purpose of this study was to determine the effect of glenoid design on immediate and follow-up radiographic lucency of pegged and keeled glenoid components, using modern cementing techniques. Material and methods: Fifty-three total shoulder arthroplasties were performed in patients with primary glenohumeral osteoarthritis. Patients were randomized prospectively to receive either a pegged or keeled glenoid component. Three raters graded radiographic glenoid lucencies. Results: On immediate radiographs, there was no significant difference in the rate of glenoid lucency between pegged (0%) and keeled (15%) glenoid components (P ¼ .128). However, after an average of 26 months, the rate of glenoid lucency was significantly higher in patients with keeled components (46%) compared to patients with pegged components (15%) (P ¼ .003). Conclusion: Even with modern cementing techniques, pegged glenoid components remain radiographically superior to keeled glenoid components. Level of evidence: Level I, Randomized Clinical Trial, Treatment study