scholarly journals Racial and Gender Shoulder Arthroplasty Utilization Disparities of High- and Low-Volume Centers in New York State

2021 ◽  
Vol 5 ◽  
pp. 247154922110419
Author(s):  
Alexander R. Markes ◽  
Ayoosh Pareek ◽  
Addisu Mesfin ◽  
C. Benjamin Ma ◽  
Derek Ward
Keyword(s):  
New York ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
New York State ◽  
High Volume ◽  
Utilization Rate ◽  
Fisher Exact Test ◽  
Group Code ◽  
Total Shoulder Arthroplasties ◽  
Shoulder Arthroplasties

Introduction The literature has consistently demonstrated utilization disparities in joint replacement procedures, though no studies have evaluated disparities in total shoulder arthroplasty with regard to operative volume. Methods We queried the New York (NY) Statewide Planning and Research Cooperative System (SPARCS) database for 32 410 total shoulder arthroplasties performed between 2009 and 2017. Patients were identified using Clinical Classifications Software code 154 for Non-Hip/Knee Arthroplasty and All Patient Refined-Diagnosis Related Group code 322 for Shoulder. Racial groups included Hispanic, non-Hispanic white, non-Hispanic black, and Other. High-volume centers were facilities that performed 2 standard deviations above the mean annual procedures. Utilization rates were calculated by dividing total shoulder arthroplasties per group by the 2010 NY Census population of that group. The Fisher exact test was used to determine significance. Results Total shoulder arthroplasty utilization increased from 43/100 000 to 73/100 000, two-thirds of which was driven by an increase in white resident utilization. More White residents per 100 000 underwent shoulder arthroplasty than Black, Hispanic, and Other residents per 100 000 residents of their respective race. White residents were 90% more likely than Hispanic residents to undergo total shoulder arthroplasty at high-volume centers ( P = .04). There were no differences in utilization rate regarding operative volume comparing Black or Other residents to White residents. More females underwent total shoulder arthroplasty than males, though there was no difference in utilization rate regarding operative volume. Conclusion Though total shoulder arthroplasty utilization nearly doubled, disparities persisted across gender and minority groups particularly in Hispanic utilization as White residents were 90% more likely than Hispanic residents to undergo shoulder arthroplasty at high-volume centers.

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

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.

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 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.

Reassessing the minimum two-year follow-up standard after total shoulder arthroplasty—Is one year sufficient?

2020 ◽  
pp. 175857322092284
Author(s):  
Kuhan A Mahendraraj ◽  
Michael P Carducci ◽  
Joseph W Galvin ◽  
Samuel W Golenbock ◽  
Florian Grubhofer ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Total Shoulder Arthroplasties ◽  
One Year ◽  
Shoulder Arthroplasties ◽  
Reverse Total Shoulder

Background US Food and Drug Administration Investigation Device Exemption studies and academic journals emphasize the importance of two-year follow-up data in reporting outcomes of total shoulder arthroplasty, but there is limited data evaluating appropriate follow-up length. We aim to evaluate change in postoperative outcomes and complications between one and two years following anatomic and reverse total shoulder arthroplasties. Methods We retrospectively identified 250 patients who underwent anatomic and reverse total shoulder arthroplasties between 2013 and 2016 from a single surgeon arthroplasty registry. Patients without both one- and two-year follow-up data were excluded. We compared American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Scale for pain, and goniometer-measured range of motion. Results Patient-reported outcome measurements ( p > 0.05) did not change between one and two years postoperatively following both reverse ( n = 146) and anatomic ( n = 104) total shoulder arthroplasties. Range of motion increased slightly ( p < 0.05), but this change was not clinically relevant. There were no additional complications. Discussion Minimum two-year clinical follow-up may not be necessary for future shoulder arthroplasty Investigation Device Exemption and other peer-reviewed investigations. Patient-reported outcomes (ASES and pain score) and range of motion plateau at one year postoperatively without additional complications. One-year follow-up is an acceptable minimum follow-up length. Level of evidence Level III—retrospective analysis.

Relationship of hospital volume on outcomes in patients with acute pulmonary embolism: Analysis of a 70,000 patient database

2020 ◽  
pp. 1358863X2097026
Author(s):  
Mark Finkelstein ◽  
Mario A Cedillo ◽  
David C Kestenbaum ◽  
Obaib S Shoaib ◽  
Aaron M Fischman ◽  
...  
Keyword(s):  
New York ◽  
Pulmonary Embolism ◽  
Length Of Stay ◽  
New York State ◽  
Multivariable Analysis ◽  
High Volume ◽  
Categorical Variables ◽  
Patient Database ◽  
Very High ◽  
Total Charges

Positive relationships between volume and outcome have been seen in several surgical and medical conditions, resulting in more centralized and specialized care structures. Currently, there is a scarcity of literature involving the volume–outcome relationship in pulmonary embolism (PE). Using a state-wide dataset that encapsulates all non-federal admissions in New York State, we performed a retrospective cohort study on admitted patients with a diagnosis of PE. A total of 70,443 cases were separated into volume groups stratified by hospital quartile. Continuous and categorical variables were compared between cohorts. Multivariable regression analysis was conducted to assess predictors of 1-year mortality, 30-day all-cause readmission, 30-day PE-related readmission, length of stay, and total charges. Of the 205 facilities that were included, 128 (62%) were labeled low volume, 39 (19%) medium volume, 23 (11%) high volume, and 15 (7%) very high volume. Multivariable analysis showed that very high volume was associated with decreased 30-day PE-related readmission (OR 0.64; 95% CI, 0.55 to 0.73), decreased 30-day all-cause readmission (OR 0.84; 95% CI, 0.79 to 0.89), decreased 1-year mortality (OR 0.85; 95% CI, 0.80 to 0.91), decreased total charges (OR 0.96; 95% CI, 0.94 to 0.98), and decreased length of stay (OR 0.94; 95% CI, 0.92 to 0.96). In summary, facilities with higher volumes of acute PE were found to have less 30-day PE-related readmissions, less all-cause readmissions, shorter length of stay, decreased 1-year mortality, and decreased total charges.

340 Trends and Disparities in Cervical Spine Fusion Procedure Utilization in the New York State

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 276-276
Author(s):  
Rui Feng ◽  
Mark Finkelstein ◽  
Eric Karl Oermann ◽  
Michael Palese ◽  
John M Caridi
Keyword(s):  
New York ◽  
African American ◽  
Cervical Spine ◽  
New York State ◽  
High Volume ◽  
Spine Fusion ◽  
York State ◽  
High Volume Hospital ◽  
Low Volume ◽  
Cervical Spine Fusion

Abstract INTRODUCTION There has been a steady increase in spinal fusion procedures performed each year in the US, especially cervical and lumbar fusion. Our study aims to analyze the rate of increase at low-, medium-, and high-volume hospitals, and socioeconomic characteristics of the patient populations at these three volume categories. METHODS We searched the New York State, Statewide Planning and Research Cooperative System (SPARCS) database from 2005 to 2014 for the ICD-9-CM Procedure Codes 81.01 (Fusion, atlas-axis), 81.02 (Fusion, anterior column, other cervical, anterior technique), and 81.03 (Fusion, posterior column, other cervical, posterior technique). Patients' primary diagnosis (ICD-9-CM), age, race/ethnicity, primary payment method, severity of illness, length of stay, hospital of operation were included. We categorized all 122 hospitals high-, medium-, and low-volume. We then described the trends in annual number of cervical spine fusion surgeries in each of the three hospital volume groups using descriptive statistics. RESULTS >African American patients were significantly greater portion of patients receiving care at low-volume hospitals, 15.1% versus 11.6% at high-volume hospital. Medicaid and self-pay patients were also overrepresented at low-volume centers, 6.7% and 3.9% versus 2.6% and 1.7% respectively at high-volume centers. In addition, Compared with Caucasian patients, African American patients had higher rates of post-operative infection (P = 0.0020) and post-operative bleeding (P = 0.0044). Compared with privately insured patients, Medicaid patients had a higher rate of post-operative bleeding (P = 0.0266) and in-hospital mortality (P = 0.0031). CONCLUSION Our results showed significant differences in racial distribution and primary payments methods between the low- and high-volume categories, and suggests that accessibility to care at high-volume centers remains problematic for these disadvantaged populations.

Effect of Implant Shape and Material Properties on Stresses in the Glenoid Components of Total Shoulder Arthroplasties: A Finite Element Analysis

2010 ◽  
Author(s):  
Jingzhou Zhang ◽  
Charlie Yongpravat ◽  
Marc D. Dyrszka ◽  
William N. Levine ◽  
Thomas R. Gardner ◽  
...  
Keyword(s):  
Humeral Head ◽  
Glenohumeral Joint ◽  
Total Shoulder Arthroplasty ◽  
Peak Stress ◽  
Glenoid Component ◽  
Joint Stability ◽  
Element Analysis ◽  
Total Shoulder Arthroplasties ◽  
Shoulder Arthroplasties ◽  
Glenoid Loosening

The geometry of the glenohumeral joint is osseous, naturally nonconforming and minimally constrained, thus the essential requirement of a glenohumeral prosthesis in total shoulder arthroplasty (TSA) is prevention of joint degeneration and glenoid loosening. A variety of glenoid prostheses have been developed. Nonconforming glenohumeral implants are common for TSA. However, the nonconforming shape increases the instability when the humeral head is in the central region, where motion frequently occurs. Conforming implants can increase joint stability, but the “rocking-horse” effect [1] caused by the conforming shape is thought to lead to high stresses and moments at the glenoid rim when the humeral head approaches the periphery during its range of motion. The hybrid design, with a conforming center and a nonconforming periphery, combines the advantages of both nonconforming and conforming implant geometries. It has been shown [2] that the peak stress generated in glenoid components during activities of daily living can be as high as 25 MPa, which exceeds the polyethylene yield strength of the glenoid component and can lead to wear and cold flow of the component. Polyethylene has also been shown to be viscoelastic [3]. Therefore, both elastic-plastic and viscoelastic-plastic models of the glenoid implant were used to determine how viscoelasticity affected stress in the implant. The effects of implant shape on the stresses in the center, transition, and superior zones for the three different glenoid implant shapes, as well as on the stress in the underlying cement and bone, were determined in this study.

Access Management

2005 ◽  
Vol 1931 (1) ◽  
pp. 117-128
Author(s):  
Jerome Gluck ◽  
Jean Michel ◽  
Michael Geiger ◽  
Maya Varughese
Keyword(s):  
New York ◽  
Traffic Congestion ◽  
Management Strategies ◽  
New York State ◽  
High Volume ◽  
York State Department ◽  
Department Of Transportation ◽  
Access Management ◽  
Accident Rate ◽  
Wide Range

This paper discusses issues encountered in developing a retrofit project for a roadway in a densely developed, commercialized area. The project was initiated, directed, and funded by the New York State Department of Transportation (NYSDOT). Numerous major shopping centers and a high volume of through traffic produce congestion and affect safety. NY-27, also known as Sunrise Highway, is a principal arterial in suburban Long Island. The conditions along NY-27 reflect what happens when development approvals are granted by local land use agencies without sufficient consideration of whether the transportation system can accommodate the associated traffic. NYSDOT, in this case, was put in the position of attempting to implement a retrofit project to mitigate the traffic and safety conditions. The proximity of shopping center driveways to each other and to nearby intersections results in weaving movements and heavy turning-movement volumes that block the through travel lanes and cause overlapping conflicts. The significant traffic congestion and high accident rate reflect the problems caused by inadequate access spacing and need for improved access management. The improvement options identified represented a wide range of access management strategies and configurations. The options were screened and modified to reflect community desires and business concerns. This paper reviews operational and safety problems, identifies a theoretical access configuration along the NY-27 corridor that could mitigate these problems, and reviews the alternative that was approved and is being progressed. The approved alternative reflects real-world considerations that affect a retrofit project.

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