Shoulder
Mihir Sheth; Daniel Sholder; Joseph Abboud; Mark Lazarus; Gerald Williams Jr; Surena Namdari
Volume 8, Issue 2 , March 2020, , Pages 147-153
Abstract
Background: The projected increase in revision shoulder arthroplasty has increased interest in the outcomes of theseprocedures. Glenoid component removal and conversion to a hemiarthroplasty (HA) is an option for aseptic glenoidloosening after anatomic total shoulder arthroplasty (aTSA).Methods: We identified ...
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Background: The projected increase in revision shoulder arthroplasty has increased interest in the outcomes of theseprocedures. Glenoid component removal and conversion to a hemiarthroplasty (HA) is an option for aseptic glenoidloosening after anatomic total shoulder arthroplasty (aTSA).Methods: We identified patients who had undergone revision shoulder arthroplasty over a 15-year period. 17 patientsmet inclusion and exclusion criteria, and a retrospective chart review was conducted for pre-surgical and operativedata. We contacted patients at a mean follow-up of 70 months from revision surgery for implant survival, reoperationsand functional outcomes scores.Results: Implant survival was estimated to be 88% at 2 years and 67% at 5 years. Mean ASES score for survivingimplants was 58 ± 22. Mean SANE score was 54 ± 24, and mean VAS pain score was 3.5 ± 2.8. Mean SF-12 Mentaland Physical scores were 46 ± 15 and 38 ± 10, respectively. Five patients (50% of those with surviving implants)reported being either very satisfied or satisfied with the status of their shoulder. There were complications in 6 patients(35%) and 5 patients (29%) required reoperation.Conclusion: HA following failed aTSA due to glenoid loosening produced modest clinical results and satisfaction rates.Reverse arthroplasty may be a more reliable treatment strategy in this patient population.Level of evidence: IV
Shoulder
Daniel Davis E.; Benjamin Zmistowski; Joseph Abboud; Surena Namdari
Volume 8, Issue 1 , January 2020, , Pages 38-43
Abstract
Background: Laminar flow ventilation systems were developed to reduce surgical contamination in joint arthroplastyto avoid periprosthetic joint infection (PJI). The goals of this study are to evaluate the cost-effectiveness and economicviability of installing and maintaining a laminar flow system in ...
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Background: Laminar flow ventilation systems were developed to reduce surgical contamination in joint arthroplastyto avoid periprosthetic joint infection (PJI). The goals of this study are to evaluate the cost-effectiveness and economicviability of installing and maintaining a laminar flow system in an operating room.Methods: A Monte Carlo simulation was used to evaluate the cost effectiveness of laminar flow. The variables includedwere cost to treat PJI, incidence of PJI, cost of laminar flow, years of operating room use, and arthroplasty volume asthe dependent variable.Results: Laminar flow would be financially-justified when 1,217 (SD: 319) TSA cases are performed annually withassumed 10% reduction in PJI from laminar flow and 487 (SD: 127) with assumed 25% reduction. In a high volume OR,laminar flow costs $25.24 per case (assuming 10% reduction) and $8.24 per case (assuming 25% reduction). Laminarflow would need to reduce the incidence of PJI by 35.1% (SD: 9.1) to be a cost-effective strategy.Conclusion: This analysis demonstrates the substantial arthroplasty volume and large reduction in PJI rates required tojustify the installation and maintenance costs of this technology. This high cost of implementation should be consideredprior to installing laminar flow systems.Level of evidence: II
Shoulder
Jeffrey D. Tompson; Usman A. Syed; Eric M. Padegimas; Joseph A. Abboud
Volume 7, Issue 6 , November 2019, , Pages 484-492
Abstract
Background: This study aimed to analyze national and institutional trends in shoulder arthroplasty utilization basedon patient race.Methods: The Nationwide Inpatient Sample (NIS) was employed to determine racial trends in shoulder arthroplastyutilization at a national level. An institutional database ...
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Background: This study aimed to analyze national and institutional trends in shoulder arthroplasty utilization basedon patient race.Methods: The Nationwide Inpatient Sample (NIS) was employed to determine racial trends in shoulder arthroplastyutilization at a national level. An institutional database was then utilized to retrospectively identify all patients, undergoingshoulder arthroplasty within 2011-2013. Descriptive statistics were used to compare self-identified black and non-blacksubpopulations.Results: The NIS identified 256,832 primary shoulder arthroplasties within 2005-2011. Black patients constituted3.92% (n=10,074) of cases. Utilization increased from 3.36% in 2005 to 4.49% in 2011. Locally, a total number of1,174 primary shoulder arthroplasties were performed, the recipients of 5.96% (n=70) of which were black. Femalesaccounted for 48/70 (68.6%) of black patients. Black patients had a higher body mass index (33.6 vs. 30.1, P<0.0001)and were younger (62.6 vs. 67.2 years, P<0.0001), compared to the non-black patients. Regarding insurance type,1,074 patients (i.e., 65 black and 1,009 non-black) had comprehensive insurance data. Chi-square analysis of fivemajor insurance categories, including private, Medicare, Medicaid, workers’ compensation, and personal injury,indicated no difference in insurance patterns (χ2=3.658, P=0.454).Conclusion: The findings revealed significant racial disparity in shoulder arthroplasty utilization both at national andinstitutional levels. This disparity exists despite the similar rates of osteoarthritis in both white and black patients. Blackpatients in our institution had similar clinical, demographic, and socioeconomic characteristics as in our non-blackpatients. The obtained results highlighted the need for the expansion of black patients’ access to care services relatedto major joint reconstruction.Level of evidence: III
Shoulder
Adam Schumaier; Joseph Abboud; Brian Grawe; J. Gabriel Horneff; Charles Getz; Gerald Williams; Matthew Ramsey; Surena Namdari; Anthony Romeo; Gregory Nicholson; Jay Keener; Richard Friedman; Ed Yian; Stephanie Muh; Ruth Delaney; Randall Otto; William Levine; JT Tokish; Jack Kazanjian; Joshua Dines; Andrew Green; Scott Paxton; Brody Flanagin; Samer Hasan; Scott Kaar; Anthony Miniaci; Frances Cuomo
Volume 7, Issue 2 , March and April 2019, , Pages 151-160
Abstract
Background: It is not always clear how to treat glenohumeral osteoarthritis, particularly in young patients. The goals ofthis study were to 1) quantify how patient age, activity level, symptoms, and radiographic findings impact the decisionmakingof shoulder specialists and 2) evaluate the observer reliability ...
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Background: It is not always clear how to treat glenohumeral osteoarthritis, particularly in young patients. The goals ofthis study were to 1) quantify how patient age, activity level, symptoms, and radiographic findings impact the decisionmakingof shoulder specialists and 2) evaluate the observer reliability of the Kellgren-Lawrence (KL) grading system forprimary osteoarthritis of the shoulder.Methods: Twenty-six shoulder surgeons were each sent 54 simulated patient cases. Each patient had a differentcombination of age, symptoms, activity level, and radiographs. Responders graded the radiographs and chose atreatment (non-operative, arthroscopy, hemiarthroplasty, or total shoulder arthroplasty). Spearman correlations andchi square tests were used to assess the relationship between factors and treatments. Sub-analysis was performedon surgical cases. An intra-class correlation (ICC) was used to assess observer agreement.Results: The significant correlations (P<0.01) were: symptoms [0.46], KL grade [0.44], and age [0.11]. In the subanalysisof operative cases, the significant correlations were: KL grade [0.64], age [0.39], and activity level [-0.10].The chi square analysis was significant (P<0.01) for all factors, but the practical significance of activity level wasminimal. The ICCs were [inter](intra): KL [0.79] (0.84), patient management [0.54].Conclusion: When evaluating glenohumeral osteoarthritis, patient symptoms and KL grade are the factors moststrongly associated with treatment. In operative cases, the factors most strongly associated with the choice of operationwere the patient’s KL grade and age. Additionally, the KL classification demonstrated excellent observer reliability.However, there was only moderate agreement among shoulder specialists regarding treatment, indicating that thisremains a controversial topic.Level of evidence: III
Shoulder
John G. Horneff; Usman Ali Syed; Adam Seidl; Jessica Britton; Gerald Williams; Joseph Abboud
Volume 7, Issue 1 , January and February 2019, , Pages 12-18
Abstract
Background: The purpose of this study was to determine a correlation between surgical case order and the length ofoperative time, total length of time in the operating room, time until discharge from the hospital, and the incidence ofintraoperative complications for primary total shoulder arthroplasty ...
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Background: The purpose of this study was to determine a correlation between surgical case order and the length ofoperative time, total length of time in the operating room, time until discharge from the hospital, and the incidence ofintraoperative complications for primary total shoulder arthroplasty cases.Methods: A retrospective review was conducted of records for all individual primary total shoulder arthroplasty andreverse total shoulder arthroplasty at a single hospital. In order to compare true parameters and minimize variables,only the cases performed by one senior author were analyzed. Operative and hospital records were reviewed.Results: There were 162 primary TSA and with the following order: 55 first order cases, 46 second order cases, 34third order cases, 21 fourth order cases, and six fifth order cases. There were 71 primary rTSA patients included (27:27:10:6:1). Length of stay was statistically increased for both female gender (8.3%; 95% confidence interval (CI)= 0.5-16.7%; P=0.0386) and fourth case order compared to first case (13.3%; 95% CI = 0.6%; 27.6%) P=0.041). For reverseTSA, there was no analyzed predictor that was significant.Conclusion: Even between anatomic TSA and reverse TSA patients, there was variability in what factors played apart in case inpatient length of stay. As such, we believe that this study highlights that case order can have an effecton operating room parameters for shoulder arthroplasty patients. The need for larger studies remains to better definethat effect.Level of evidence: IV
Shoulder
Alexis A. Williams; Eric H. Tischler; Daniel Sholder; Thema A. Nicholson; Mitchell G. Maltenfort; Charles Getz; Gerald Williams Jr; Surena Namdari
Volume 6, Issue 4 , July 2018, , Pages 282-288
Abstract
Purpose Purpose The purpose of this study was to determine patient-specific risk factors and clinical intervention rates for abnormal postoperative Chem-7 panels in shoulder arthroplasty patients. Methods Retrospectively, all primary anatomic total (aTSA) and reverse shoulder (RTSA) arthroplasties ...
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Purpose Purpose The purpose of this study was to determine patient-specific risk factors and clinical intervention rates for abnormal postoperative Chem-7 panels in shoulder arthroplasty patients. Methods Retrospectively, all primary anatomic total (aTSA) and reverse shoulder (RTSA) arthroplasties (between 2007-2013) performed at a single institution were identified. All patients underwent routine preoperative and postoperative day one (POD1) chemistry panels. Each clinically significant component of the Chem-7 panel was independently evaluated using a multivariate analysis to identify risk factors for abnormal results. Associated clinical intervention rates were also calculated. Results Data from 1,012 patients (248 RTSA; 764 aTSA) was analyzed. 5.4% of patients had at least one preoperative abnormal chemistry result. On multivariate analysis, patients with abnormal preoperative Chem-7 labs and a history of renal disease had significantly increased risk for abnormal POD1 labs (p <0.001). Although 25.6% (259/1,012) of patients had at least one abnormal POD1 lab result, the total postoperative clinical intervention rate was 15.1% (39/259). Conclusion Renal disease and a preoperative abnormal chemistry result are important risk factors for abnormal postoperative Chem-7. Optimizing renal status and correcting abnormal blood chemistry results preoperatively may reduce the incidence of abnormal postoperative chemistry results.