scholarly journals Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative Times

2019 ◽  
Vol 3 ◽  
pp. 247154921988213
Author(s):  
Tyler A Luthringer ◽  
Benjamin S Kester ◽  
Oluwadamilola Kolade ◽  
Mandeep S Virk ◽  
Michael J Alaia ◽  
...  
Keyword(s):  
Risk Factor ◽  
Shoulder Arthroplasty ◽  
Independent Risk Factor ◽  
Hospital Admissions ◽  
Total Shoulder Arthroplasty ◽  
Posttraumatic Arthritis ◽  
Improvement Program ◽  
Primary Osteoarthritis ◽  
Poor Outcomes ◽  
Reverse Total Shoulder

Introduction: Posttraumatic arthritis (PTA) is a common sequela of proximal humerus fractures that is commonly managed with anatomic or reverse total shoulder arthroplasty (TSA). TSA for PTA is more challenging than that performed for primary osteoarthritis and frequently leads to worse patient outcomes. CPT uniformly classifies all cases of primary TSA, irrespective of procedural complexity and resource utilization. This study analyzes intraoperative differences and 30-day outcomes for anatomic and reverse TSA performed in the posttraumatic shoulder. Methods: Patients undergoing TSA from 2008 to 2015 were selected from the National Surgical Quality Improvement Program database and stratified according to concurrent procedures and administrative codes indicating posttraumatic diagnoses. Perioperative parameters and 30-day complications were recorded; multivariate analyses were performed to determine whether PTA was a risk factor for poor outcomes. Results: A total of 8508 primary and 243 posttraumatic TSAs were identified. Posttraumatic TSA patients were slightly younger ( P = .003), more likely to be female ( P < .001), smokers ( P = .029), and diabetic ( P =  .003). Diagnosis of PTA was an independent risk factor for prolonged operative times ≥160 minutes (≥1 standard deviation above the mean, P =  .003; odds ratio [OR]: 1.718; 95% confidence interval [CI]: 1.204–2.449) and increased bleeding requiring transfusion ( P <  .001; OR: 2.719; 95% CI: 1.607–4.600). Although posttraumatic TSA had a tendency for longer hospital admissions, 30-day readmissions were not significantly different between cohorts. Conclusions: Compared with primary osteoarthritis, a preoperative diagnosis of PTA is an independent risk factor for prolonged operative times and postoperative transfusion in anatomic or reverse TSA patients; such patients may be less than optimal candidates for same-day discharges or outpatient shoulder arthroplasty.

scholarly journals A higher altitude is an independent risk factor for venous thromboembolisms following total shoulder arthroplasty

2018 ◽  
Vol 15 (4) ◽  
pp. 1017-1021 ◽  
Author(s):  
Dhanur Damodar ◽  
Rushabh Vakharia ◽  
Ajit Vakharia ◽  
Jon Sheu ◽  
Chester J. Donnally ◽  
...  
Keyword(s):  
Risk Factor ◽  
Shoulder Arthroplasty ◽  
Independent Risk Factor ◽  
Total Shoulder Arthroplasty

scholarly journals Does Preservation of Coracoacromial Ligament Reduce the Acromial Stress Pathology Following Reverse Total Shoulder Arthroplasty?

2021 ◽  
Vol 5 ◽  
pp. 247154922110221
Author(s):  
Chang Hee Baek, MD ◽  
Jung Gon Kim, MD ◽  
Dong Hyeon Lee, MD ◽  
Gyu Rim Baek
Keyword(s):  
Risk Factor ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Clinical Score ◽  
Reverse Total Shoulder Arthroplasty ◽  
Occult Fracture ◽  
Coracoacromial Ligament ◽  
Group 2 ◽  
Reverse Total Shoulder ◽  
Group 1

Introduction Acromial pathologies (AP), such as acromial stress reaction (ASR), acromial stress occult fracture (ASOF), and acromial stress fracture (ASF), are known as complications that deteriorate the clinical score and patient satisfaction after reverse total shoulder arthroplasty (RSA). Several factors that increase stress on the acromion have been reported as risk factors for AP, but this is also unclear. Thecoracoacromial ligament (CAL) is a structure that distributes the stress loading on such an acromion, although its importance has been mentioned, there is a lack of research. Therefore, we investigated the incidence of AP according to the preservation of the CAL and whether it is a risk factor. Methods The study was retrospectively conducted on patients who underwent RSA from 2016 and 2018. Patients with CAL transection was classified into group 1 and CAL preservation was classified into group 2. ASR and ASOF were identified through symptoms and ultrasound, and ASF identified through simple radiograph or computed tomography. The incidence of AP in each group was checked and compared. Results Of the total of 265 patients. Among 197 cases of group 1, 21 cases of ASR(10.7%), 28 cases of ASOF (14.2%),10 cases of ASF (5.1%), and 59 cases of total AP (29.4%). Among 68 cases in group 2, 2 cases (2.9%) of ASR, 6 cases of ASOF(8.8%), 1 case of ASF (1.5%), and 9 cases of total AP (13.2%). It was confirmed that ASR and ASOP were significantly decreased in the group preserving CAL. (P = .008) Conclusion In the case of preservation of CAL during surgery, it was confirmed that the incidence of ASR, ASOF was reduced. Therefore, preservation of CAL can be regarded as a modifiable risk factor that can reduce the risk of AP by distributing the stress applied to acromion after RSA surgery.

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