Utilization of comorbidity indices to predict discharge destination and complications following total shoulder arthroplasty

2021 ◽  
pp. 175857322110497
Author(s):  
Ryan M. Cox ◽  
Benjamin A. Hendy ◽  
Michael J. Gutman ◽  
Matthew Sherman ◽  
Joseph A. Abboud ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Discharge Planning ◽  
Total Shoulder Arthroplasty ◽  
Frailty Index ◽  
Reoperation Rate ◽  
Discharge Destination ◽  
Lengths Of Stay ◽  
Physical Status Classification ◽  
Patients At Risk ◽  
Shoulder Arthroplasties

Background Comorbidity indices can help identify patients at risk for postoperative complications. Purpose of this study was to compare different comorbidity indices to predict discharge destination and complications after shoulder arthroplasty. Methods Retrospective review of institutional shoulder arthroplasty database of primary anatomic (TSA) and reverse (RSA) shoulder arthroplasties. Patient demographic information was collected in order to calculate Modified Frailty Index (mFI-5), Charlson Comorbidity Index (CCI), age adjusted CCI (age-CCI), and American Society of Anesthesiologists physical status classification system (ASA). Statistical analysis performed to analyze length of stay (LOS), discharge destination, and 90-day complications. Results There were 1365 patients included with 672 TSA and 693 RSA patients. RSA patients were older and had higher CCI, age adjusted CCI, ASA, and mFI-5 ( p < 0.001). RSA patients had longer lengths of stay (LOS), more likely to have an adverse discharge ( p < 0.001), and higher reoperation rate ( p = 0.003). Age-CCI was most predictive of adverse discharge (AUC 0.721, 95% CI 0.704–0.768). Discussion Patients undergoing RSA had more medical comorbidities, experienced greater LOS, higher reoperation rate, and were more likely to have an adverse discharge. Age-CCI had the best ability to predict which patients were likely to require higher-level discharge planning.

Anatomic versus reverse shoulder arthroplasty: a mid-term follow-up comparison

2020 ◽  
pp. 175857322092115
Author(s):  
Bradley S Schoch ◽  
Joseph J King ◽  
Joseph Zuckerman ◽  
Thomas W Wright ◽  
Chris Roche ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reoperation Rate ◽  
Patient Reported ◽  
Total Shoulder Arthroplasties ◽  
Shoulder Arthroplasties

Background Anatomic total shoulder arthroplasty improves pain and function with a reported reoperation rate of approximately 1% per year. With improved glenoid fixation, reverse shoulder arthroplasty implants may outperform anatomic total shoulder arthroplasty. We evaluate the functional outcomes and reoperation rate of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty at a minimum eight-year follow-up or revision. Methods Between 2005 and 2010, 187 shoulders (137 anatomic total shoulder arthroplasty, 50 reverse shoulder arthroplasty) were retrospectively reviewed at a mean of 8.8 years. The mean age at surgery was 67 years. Females were more commonly treated with reverse shoulder arthroplasty. Both groups had similar body mass index and comorbidities. Outcome measures evaluated included abduction, forward elevation, external rotation, internal rotation, Simple Shoulder Test, Constant score, American Shoulder and Elbow Score, University of California Los Angeles Shoulder score, and Shoulder Pain and Disability Index. Results At follow-up, anatomic total shoulder arthroplasty demonstrated greater overhead range of motion and external rotation. All patient-reported outcomes remained similar between groups. Reverse shoulder arthroplasty patients were more likely to rate shoulders as much better or better after surgery (90% versus 67%, p = 0.004). Complications were observed in 24% of anatomic total shoulder arthroplasties and 8% of reverse shoulder arthroplasties (p = 0.02). Reoperation was more common in anatomic total shoulder arthroplasties (23% versus 4%, p = 0.003). Discussion At mid-to-long-term follow-up, reverse shoulder arthroplasties demonstrated significantly fewer complications and reoperations than anatomic total shoulder arthroplasties. Despite similar patient-reported outcomes, reverse shoulder arthroplasty patients were more likely to be satisfied with their shoulder.

Glenoid bone grafting in primary anatomic total shoulder arthroplasty: a systematic review

2020 ◽  
pp. 175857322091765
Author(s):  
Betty Zhang ◽  
Gavinn Niroopan ◽  
Chetan Gohal ◽  
Bashar Alolabi ◽  
Timothy Leroux ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Bone Grafting ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Level Of Evidence ◽  
Total Shoulder Arthroplasties ◽  
Component Loosening ◽  
Shoulder Arthroplasties

Background Primary anatomic total shoulder arthroplasty can be challenging in patients with complex glenoid wear patterns and bone loss. Severe retroversion (>15°) or significant bone loss may require bone grafting. This review summarizes the rate of revision and long-term outcomes of anatomic total shoulder arthroplasty with bone graft. Methods A systematic search of MEDLINE, Embase, PubMed, and CENTRAL databases was conducted from the date of inception to 23 October 2018. Two reviewers independently screened articles for eligibility and extracted data for analysis. The primary outcome was rate of revision. The secondary outcomes were rate of component loosening, functional outcome, and range of motion. Results Of the 1056 articles identified in the search, 26 underwent full-text screening and 7 articles were included in the analysis. All procedures were one-stage anatomic total shoulder arthroplasties. The rate of revision was 5.4% with component loosening and infection listed as indications over a weighted mean follow-up period of 6.3 years. Complications occurred in 12.6% of patients. Conclusion Glenoid bone grafting in anatomic total shoulder arthroplasty results in comparable revision rates and improvement in pain compared to augmented glenoid components and reverse shoulder arthroplasty. Due to the low quality of evidence, further prospective studies should be conducted. Level of evidence IV

scholarly journals Fretting and Corrosion in Modular Shoulder Arthroplasty: A Retrieval Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Johannes A. Eckert ◽  
Ulrike Mueller ◽  
Sebastian Jaeger ◽  
Benjamin Panzram ◽  
J. Philippe Kretzer
Keyword(s):  
Titanium Alloy ◽  
Shoulder Arthroplasty ◽  
Metal Ion ◽  
Total Shoulder Arthroplasty ◽  
Elevated Serum ◽  
Cobalt Chromium ◽  
Weak Correlation ◽  
Metal Debris ◽  
Total Shoulder Arthroplasties ◽  
Shoulder Arthroplasties

Tribocorrosion in taper junctions of retrieved anatomic shoulder arthroplasty implants was evaluated. A comparison of the tribocorrosion between cobalt-chromium and titanium alloy stems was conducted and the observations were correlated with the individual’s clinical data. Adverse effects caused by metal debris and subsequent elevated serum metal ion levels are frequently reported in total hip arthroplasty. In total shoulder arthroplasty, to date only a small number of retrieval analyses are available and even fewer address the issue of tribocorrosion at the taper junctions. A total of 36 retrieved hemiarthroplasties and total shoulder arthroplasties were assessed using the modified Goldberg score. The prevalence of fretting and corrosion was confirmed in this cohort. Titanium stems seem to be more susceptible to damage caused by tribocorrosion than cobalt-chromium stems. Furthermore, stemless designs offered less tribocorrosion at the taper junction than stemmed designs. A weak correlation between time to revision and increased levels of tribocorrosion was seen. Whether or not tribocorrosion can lead to adverse clinical reactions and causes failure of shoulder arthroplasties remains to be examined.

scholarly journals COVID-19 as a Catalyst for Same-Day Discharge Total Shoulder Arthroplasty

2021 ◽  
Vol 10 (24) ◽  
pp. 5908
Author(s):  
Mariano E. Menendez ◽  
Noah Keegan ◽  
Brian C. Werner ◽  
Patrick J. Denard
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Patient Characteristics ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Discharge Rates ◽  
Same Day Discharge ◽  
Discharge Location ◽  
Ed Visits ◽  
Shoulder Arthroplasties

The COVID-19 pandemic caused major disruptions to the healthcare system, but its impact on the transition to same-day discharge shoulder arthroplasty remains unexplored. This study assessed the effect of COVID-19 on length of stay (LOS), same-day discharge rates, and other markers of resource use after elective total shoulder arthroplasty. A total of 508 consecutive patients undergoing elective primary total shoulder arthroplasty between 2019 and 2021 were identified and divided into 2 cohorts: “pre-COVID” (March 2019–March 2020; n = 263) and “post-COVID” (May 2020–March 2021; n = 245). No elective shoulder arthroplasties were performed at our practice between 18 March and 11 May 2020. Outcome measures included LOS, same-day discharge, discharge location, and 90-day emergency department (ED) visits, readmissions and reoperations. There were no significant differences in baseline preoperative patient characteristics. Shoulder arthroplasty performed post-COVID was associated with a shorter LOS (12 vs. 16 h, p = 0.017) and a higher rate of same-day discharge (87.3 vs. 79.1%, p = 0.013). The rate of discharge to skilled nursing facilities was similarly low between the groups (1.9 vs. 2.0%, p = 0.915). There was a significant reduction in the rate of 90-day ED visits post-COVID (7.4 vs. 13.3%, p = 0.029), while there were no differences in 90-day reoperation (2.0 vs. 1.5%, p = 0.745) or readmission rates (1.2 vs. 1.9%, p = 0.724). The COVID-19 pandemic seems to have accelerated the shift towards shorter stays and more same-day discharge shoulder arthroplasties, while reducing unexpected acute health needs (e.g., ED visits) without adversely affecting readmission and reoperation rates.

Modified frailty index is an effective risk-stratification tool for patients undergoing total shoulder arthroplasty

2019 ◽  
Vol 28 (7) ◽  
pp. 1232-1240 ◽  
Author(s):  
Russell E. Holzgrefe ◽  
Jacob M. Wilson ◽  
Christopher A. Staley ◽  
Travis L. Anderson ◽  
Eric R. Wagner ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Frailty Index ◽  
Risk Stratification Tool ◽  
Modified Frailty Index

scholarly journals Anatomic Total Shoulder Arthroplasty Using a Self-Pressurizing Pegged Bone-Preserving Cemented Glenoid Component: A 2- to 5-Year Follow-up Study

2018 ◽  
Vol 2 ◽  
pp. 247154921775047
Author(s):  
Joaquin Sanchez-Sotelo ◽  
Ngoc Tram V Nguyen ◽  
Mark Morrey
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Loose Body ◽  
Deep Infection ◽  
Glenoid Component ◽  
Total Shoulder Arthroplasties ◽  
Shoulder Arthroplasties ◽  
And Function

Background: High rates of radiographic loosening have been reported with various glenoid designs. Many available designs sacrifice most of the bone at the central portion of the glenoid vault, creating large areas of deficiency when revision becomes necessary. The purpose of this study was to report the 2- to 5-year outcome of shoulder arthroplasty using a bone-preserving all-polyethylene glenoid components with self-pressurizing pegs. Methods: Between August 2011 and December 2014, 202 consecutive anatomic total shoulder arthroplasties (TSAs) were performed by a single surgeon with implantation of a self-pressurizing cemented pegged glenoid component in 190 patients (12 patients had both shoulders replaced). Patients were followed up prospectively and evaluated for pain, motion, strength, American Shoulder and Elbow Surgeons (ASES) scores, and radiographic changes. The mean follow-up time was 2.7 (2–5) years. Results: TSA improved pain and function reliably. At the most recent follow-up, 94% of the shoulders had no or mild pain. Motion included 154 ± 25° of elevation, 68 ± 18° of external rotation, and median internal rotation to T10 (range, iliac crest to T4). The most recent average ASES score was 82 ± 15 points. Early postoperative radiographs showed no radiolucent lines. No humeral or glenoid component was considered radiographically loose at the most recent follow-up. Complications requiring reoperation included subscapularis insufficiency (4), posterior instability (2), deep infection (1), stiffness (1), and a painful loose body (1). No components were revised for loosening. Conclusions: Anatomic TSA using a cemented bone-preserving all-polyethylene pegged self-pressurizing glenoid component provided satisfactory clinical outcomes and survival at 2 to 5 years.

Modified frailty index predicts medical complications, length of stay, readmission, and mortality following total shoulder arthroplasty

2019 ◽  
Vol 28 (10) ◽  
pp. 1854-1860 ◽  
Author(s):  
Sophia A. Traven ◽  
Kathy M. McGurk ◽  
Russell A. Reeves ◽  
Zeke J. Walton ◽  
Shane K. Woolf ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Frailty Index ◽  
Medical Complications ◽  
Modified Frailty Index

scholarly journals Accuracy of Humeral Implant Positioning Using a Canal-Sparing Total Shoulder Arthroplasty System

2019 ◽  
Vol 3 ◽  
pp. 247154921984483
Author(s):  
Eric S Baranek ◽  
David P Trofa ◽  
William N Levine ◽  
Steven S Goldberg
Keyword(s):  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
Total Shoulder Arthroplasty ◽  
Case Series ◽  
Humeral Head Prosthesis ◽  
The Difference ◽  
Clinically Significant ◽  
Shoulder Arthroplasties ◽  
Improved Accuracy

Background Accurate restoration of anatomy is critical in reestablishing proper glenohumeral joint function in total shoulder arthroplasty (TSA). However, even experienced surgeons inconsistently achieve anatomic restoration. This study evaluates whether a new canal-sparing arthroplasty system, designed using the principles of calibrated bone resection and incorporating a nonspherical humeral head prosthesis, can assist in more accurate and reliable reproduction of proximal humeral anatomy compared to a stemmed arthroplasty system. Methods The difference between the anatomic center of rotation (COR) of the humeral head and the postoperative prosthetic COR (defined as ΔCOR) was measured in a consecutive case series of 110 shoulder arthroplasties performed by a single surgeon. The first 55 cases used a stemmed arthroplasty system and the subsequent 55 cases used a new canal-sparing implant system that uses a multiplanar osteotomy (MPO) during humeral head preparation. Cases with ΔCOR ≥3.0 mm were deemed clinically significant outliers. Results The average ΔCOR in the MPO group was 1.7 ± 1.2 mm versus 2.8 ± 1.5 mm in the stemmed group ( P = .00005). The incidence of outliers was lower (14.5% vs 40.0%, P = .005), and there were more cases with a ΔCOR ≤1.0 mm (32.7% vs 3.6%, P = .0001) in the MPO group compared to the stemmed group. Conclusion The MPO TSA system provided improved accuracy and precision in restoring proximal humeral anatomy compared to stemmed arthroplasty systems, even in its initial use. This alternative method of humeral replacement may increase consistency in restoring proper anatomy and kinematics in TSA.

scholarly journals Assessment of Shoulder Mobility and Stability in Reverse Total Shoulder Arthroplasty: a Sensor Perspective

10.29007/dlq8 ◽  
2019 ◽  
Author(s):  
Matthias Verstraete ◽  
Michael Conditt ◽  
Moby Parsons ◽  
Joseph Decerce ◽  
Gordon Goodchild ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Clinical Value ◽  
Load Sensor ◽  
Shoulder Arthroplasties ◽  
Reverse Total Shoulder

In reverse total shoulder arthroplasty stability is primarily controlled by the soft-tissue constraints rather than the congruency of the articulating surfaces. However, assessing the tension in these stabilizing structures currently remains highly subjective intra- operatively. In an attempt to quantify this feel during surgery, an intra-articular load sensor is introduced in this paper. In an in-vitro setting, the load sensor was used in eight reverse total shoulder arthroplasties on full torso specimens. The specimens were mounted on an inclined chair, such that the scapula could freely move to mimic surgical conditions. The resulting load vectors were captured through the range of motion under three different conditions, subjectively categorized by the surgeon as having a low, normal and high tightness. In neutral rotation and under a subjectively optimal condition assessed as neither too tight nor too loose, glenohumeral loads in the range of 10-20lbs were observed. For the same subjectively assessed optimal shoulder, loads up to 30lbs were observed under maximum internal/external humeral rotation. This contrasts the subjectively assessed loose and tight conditions, where lower resp. higher loads were observed that additionally affected the range of motion. On the other hand, stability was potentially missing under loose conditions as no increase in load was observed near the limits of the range of motion, indicating the lack of soft tissue restraint. In conclusion, this series of in- vitro experiments has shown the relevance and potential clinical value of assessing a shoulder’s stability and mobility using intra-articular load measurements during the trialing phase.

scholarly journals Multimodality imaging in shoulder arthroplasties Part 1: Biomechanics, indications, preoperative imaging, and types of arthroplasties – A pictorial review

2021 ◽  
Vol 3 ◽  
pp. 24-29
Author(s):  
Matthew Sarvesvaran ◽  
Siddharth Thaker ◽  
Suresh Srinivasan ◽  
Rahatdeep Singh Brar ◽  
Raj Bhatt ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Humeral Head ◽  
Multimodality Imaging ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Preoperative Imaging ◽  
Shoulder Biomechanics ◽  
Case Examples ◽  
Pictorial Review ◽  
Shoulder Arthroplasties

Shoulder biomechanics, shoulder arthroplasty indications and types and appropriate pre-operative imaging are discussed in part one of this two-part pictorial review. Shoulder biomechanics in severe osteoarthritis and following reverse shoulder arthroplasty are represented graphically, with discussion on the principles of reverse shoulder arthroplasty. Case examples are utilized to demonstrate the main indications for shoulder arthroplasty. The decision of whether to proceed with arthroplasty and the arthroplasty type is heavily influenced by the pre-operative imaging. Factors for type of arthroplasty include arthroplasty indication, the integrity of the deltoid and rotator cuff musculature, and the amount of glenoid and humeral head bone stock. The key findings to look for and comment on across a range of imaging modalities are reviewed, using multiple cases including plain radiography, CT, ultrasound, and MRI. Examples of arthroplasty options are provided including humeral head resurfacing arthroplasty, hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty. A good understanding of the above principles is crucial for the radiologist to interpret pre-operative imaging correctly and aid in surgical planning.

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