Coronary artery calcification score and 19 biomarkers on cardiovascular events; a 10-year follow-up DanRisk substudy.

Aim: The SCORE2 algorithm is recommended to estimate risk of cardiovascular disease (CVD). Coronary artery calcification (CAC) score is expensive but improves the risk prediction. This study aims to determine and compare the additive value of CAC-score and 19 biomarkers in risk prediction. Methods: Traditional cardiovascular (CV) risk factors, CAC-score, and a wide range of biomarkers (including lipids, calcium-phosphate metabolism, troponin, inflammation, kidney function and ankle brachial index (ABI)) were collected from 1211 randomly selected middle-aged men and women in this multicenter prospective cohort in 2009-2010. 10-year follow-up data on CV-events were obtained via the Danish Health Registries. CV-event was defined as stroke, myocardial infarction, hospitalization for heart failure, coronary artery revascularization or death from CVD. The association between SCORE2, CAC-score, biomarkers, and CV-events was assessed using cox proportional hazard rates (HR) and compared using AUC-calculation of ROC-curves. Finally, net reclassification improvement (NRI) was calculated. Results: 92 participants had CV-events. Adjusted for risk factors, CAC-score was significantly associated with events (adjusted HR 1.9 (95%CI:1.1; 3.3), 3.6 (95%CI:1.9; 6.8), and 5. (95%CI:2.6; 10.3) for CAC-score 1-99, CAC-score 100-399 and CAC-score ≥400, respectively. HR for the highest quartile of CRP was 2.3 (95%CI:1.2; 4.5), while none of the remaining biomarkers improved HR. Adjusted for SCORE2, the CAC-score improved AUC (AUCCAC: 0.72, AUCSCORE2: 0.67, p<0.01). A combination of selected biomarkers (total cholesterol, low-density lipoprotein, phosphate, troponin, CRP, and creatinine) borderline improved AUC (AUCBiomarkers + SCORE2: 0.71, AUCSCORE2: 0.67, p=0.06). NRI for CAC score was 63 % (p<0.0001). Conclusion: CAC-score improved prediction of CV-events, however the selected biomarkers did not.

Risk of prolonged postoperative opioid use after elective shoulder replacement: a nationwide cohort study of 5,660 patients from the Danish Shoulder Arthroplasty Registry.

BACKGROUND AND PURPOSE: Several studies from the United States report an increased risk of prolonged opioid use after shoulder replacement. We aimed to determine the incidence and risk factors of prolonged opioid use after elective shoulder replacement in a nationwide Danish population. METHODS: All primary elective shoulder arthroplasties reported to the Danish Shoulder Arthroplasty Registry (DSR) from 2004 to 2020 were screened for eligibility. Data on potential risk factors was retrieved from the DSR and the National Danish Patient Registry while data on medication was retrieved from the Danish National Health Service Prescription Database. Prolonged opioid use was defined as 1 or more dispensed prescriptions on and 90 days after date of surgery (Q1) and subsequently 1 or more dispensed prescriptions 91-180 days after surgery (Q2). Preoperative opioid use was defined as 1 or more dispensed prescriptions 90 days before surgery. Logistic regression models were used to estimate risk factors for prolonged opioid use. RESULTS: We included 5,660 patients. Postoperatively 1,584 (28%) patients were dispensed 1 or more prescriptions in Q1 and Q2 and were classified as prolonged opioid users. Among the 2,037 preoperative opioid users and the 3,623 non-opioid users, 1,201 (59%) and 383 (11%) respectively were classified as prolonged users. Preoperative opioid use, female sex, alcohol abuse, previous surgery, high Charlson Comorbidity index, and preoperative use of either antidepressants, antipsychotics, or benzodiazepines were associated with increased risk of prolonged opioid use. CONCLUSION: The incidence of prolonged opioid use was 28%. Preoperative use of opioids was the strongest risk factor for prolonged opioid use, but several other risk factors were identified for prolonged opioid use.

Risk of serious adverse events after primary shoulder replacement: development and external validation of a prediction model using linked national data from England and Denmark.

BACKGROUND: Despite a rising rate of serious medical complications after shoulder replacement surgery, there are no prediction models in widespread use to guide surgeons in identifying patients at high risk and to provide patients with personalised risk estimates to support shared decision making. Our aim was to develop and externally validate a prediction model for serious adverse events within 90 days of primary shoulder replacement surgery. METHODS: Linked data from the National Joint Registry, National Health Service Hospital Episode Statistics Admitted Patient Care of England, and Civil Registration Mortality databases and Danish Shoulder Arthroplasty Registry and National Patient Register were used for our modelling study. Patients aged 18-100 years who had a primary shoulder replacement between April 1, 2012, and Oct 2, 2020, in England, and April 1, 2012, and Oct 2, 2018, in Denmark, were included. We developed a multivariable logistic regression model using the English dataset to predict the risk of 90-day serious adverse events, which were defined as medical complications requiring admission to hospital and all-cause death. We undertook internal validation using bootstrapping, and internal-external cross-validation across different geographical regions of England. The English model was externally validated on the Danish dataset. FINDINGS: Data for 40 631 patients undergoing primary shoulder replacement (mean age 72·5 years [SD 9·9]; 28 709 [70·7%] women and 11 922 [29·3%] men) were used for model development, of whom 2270 (5·6%) had a 90-day serious adverse event. On internal validation, the model had a C-statistic of 0·717 (95% CI 0·707-0·728) and was well calibrated. Internal-external cross-validation showed consistent model performance across all regions in England. Upon external validation on the Danish dataset (n=6653; mean age 70·5 years [SD 10·3]; 4503 [67·7%] women and 2150 [32·3%] men), the model had a C-statistic of 0·750 (95% CI 0·723-0·776). Decision curve analysis showed clinical utility, with net benefit across all risk thresholds. INTERPRETATION: This externally validated prediction model uses commonly available clinical variables to accurately predict the risk of serious medical complications after primary shoulder replacement surgery. The model is generalisable and applicable to most patients in need of a shoulder replacement. Its use offers support to clinicians and could inform and empower patients in the shared decision-making process. FUNDING: National Institute for Health and Care Research and the Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, Denmark.

High revision rate of metal-backed glenoid component and impact on the overall revision rate of stemless total shoulder arthroplasty: a cohort study from the Danish Shoulder Arthroplasty Registry.

BACKGROUND AND PURPOSE: There is controversy regarding the results of stemmed and stemless total shoulder arthroplasty (TSA) used for osteoarthritis. Therefore, we aimed to compare revision rates of stemmed and stemless TSA and to examine the impact of metal-backed glenoid components. METHODS: We included all patients reported to the Danish Shoulder Arthroplasty Register from January 1, 2012 to December 31, 2022 with an anatomical TSA used for osteoarthritis. Primary outcome was revision (removal or exchange of components) for any reason. RESULTS: 3,338 arthroplasties were included. The hazard ratio for revision of stemless TSA adjusted for age and sex was 1.83 (95% confidence interval [CI] 1.21-2.78) with stemmed TSA as reference. When excluding all arthroplasties with a metal-backed glenoid component, the adjusted hazard ratio for revision of stemless TSA was 1.37 (CI 0.85-2.20). For the Eclipse stemless TSA system, the adjusted hazard ratio for revision of a metal-backed glenoid component was 8.75 (CI 2.40-31.9) with stemless Eclipse with an all-polyethylene glenoid component as reference. CONCLUSION: We showed that the risk of revision of stemless TSAs was increased and that it was related to their combination with metal-backed glenoid components.

Sound evidence for biodiversity monitoring.

Bioacoustics and artificial intelligence facilitate ecological studies of animal populations.

The Copenhagen Classification System for Distal Humeral Fractures is useful to identify patients who may require treatment with hemi- or total elbow arthroplasty.

Background: Classification systems are only useful if there is agreement among observers. The purpose of this study is to introduce a simple and clinically applicable classification system - The Copenhagen Classification System for Distal Humeral Fractures (CCDHF) and to compare the interobserver and intraobserver agreement for this classification with the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA), and the Sheffield classification systems. The primary objective of the new classification system is to distinguish fractures that may not be suitable for open reduction and internal fixation, necessitating treatment options such as elbow hemiarthroplasty or total elbow arthroplasty (TEA). Methods: Five consultant elbow surgeons assessed a consecutive series of 105 sets X-rays of distal humeral fractures on 2 occasions with at least 10 weeks interval. All X-rays were classified according to AO/OTA, Sheffield, and the CCDHF systems. The CCDHF system has been developed collaboratively by a panel of five experienced elbow surgeons. Based on consensus, the surgeons identified specific fracture characteristics where elbow hemiarthroplasty or TEA might be needed. Results: The mean interobserver agreement was fair for AO/OTA and moderate for Sheffield and the CCDHF. The mean intraobserver agreement was moderate for AO/OTA and substantial for Sheffield and the CCDHF. The observers were uncertain about the classification in 29% of the cases with the AO/OTA classification, 15% with the Sheffield classification, and 12% with CCDHF. Conclusion: The CCDHF demonstrated validity and clinical applicability and can assist surgeons in identifying fractures that may require hemiarthroplasty or TEA treatment.

European Society for Surgery of the Shoulder and Elbow (SECEC) rotator cuff tear registry Delphi consensus.

Background: The purpose of this study was to establish consensus statements via a Delphi process on the factors that should be included in a registry for those patients undergoing rotator cuff tear treatment. Methods: A consensus process on the treatment of rotator cuff utilizing a modified Delphi technique was conducted. Fifty-seven surgeons completed these consensus statements and 9 surgeons declined. The participants were members of the European Society for Surgery of the Shoulder and Elbow committees representing 23 European countries. Thirteen questions were generated regarding the diagnosis and follow-up of rotator cuff tears were distributed, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80%-89% agreement, whereas strong consensus was defined as 90%-99% agreement, and unanimous consensus was defined by 100% agreement with a proposed statement. Results: Of the 13 total questions and consensus statements on rotator cuff tears, 1 achieved unanimous consensus, 6 achieved strong consensus, 5 achieved consensus, and 1 did not achieve consensus. The statement that reached unanimous consensus was that the factors in the patient history that should be evaluated and recorded in the setting of suspected/known rotator cuff tear are age, gender, comorbidities, smoking, traumatic etiology, prior treatment including physical therapy/injections, pain, sleep disturbance, sports, occupation, workmen's compensation, hand dominance, and functional limitations. The statement that did not achieve consensus was related to the role of ultrasound in the initial diagnosis of patients with rotator cuff tears. Conclusion: Nearly all questions reached consensus among 57 European Society for Surgery of the Shoulder and Elbow members representing 23 different European countries. We encourage surgeons to use this minimum set of variables to establish rotator cuff registries and multicenter studies. By adapting and using compatible variables, data can more easily be compared and eventually merged across countries.

Comparable low revision rates of stemmed and stemless total anatomic shoulder arthroplasties after exclusion of metal-backed glenoid components: a collaboration between the Australian and Danish national shoulder arthroplasty registries.

BACKGROUND: The stemmed anatomic total shoulder arthroplasty is the gold standard in the treatment of glenohumeral osteoarthritis. However, the use of stemless total shoulder arthroplasties has increased in recent years. The number of revision procedures are relatively low, and therefore it has been recommended that national joint replacement registries should collaborate when comparing revision rates. Therefore, we aimed to compare the revision rates of stemmed and stemless TSA used for the diagnosis of glenohumeral osteoarthritis using data from both the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and the Danish Shoulder Arthroplasty Registry (DSR). METHODS: We included all patients who were registered in the AOANJRR and the DSR from January 1, 2012, to December 2021 with an anatomic total shoulder arthroplasty used for osteoarthritis. Revision for any reason was used as the primary outcome. We used the Kaplan-Meier method to illustrate the cumulative revision rates and a multivariate cox regression model to calculate the hazard ratios. All analyses were performed separately for data from AOANJRR and DSR, and the results were then reported using a qualitative approach. RESULTS: A total of 13,066 arthroplasties from AOANJRR and 2882 arthroplasties from DSR were included. The hazard ratio for revision of stemmed TSA with stemless TSA as reference, adjusted for age and gender, was 1.67 (95% confidence interval [CI] 1.34-2.09, P < .001) in AOANJRR and 0.57 (95% CI 0.36-0.89, P = .014) in DSR. When including glenoid type and fixation, surface bearing (only in AOANJRR), and hospital volume in the cox regression model, the hazard ratio for revision of stemmed TSA compared to stemless TSA was 1.22 (95% CI 0.85-1.75, P = .286) in AOANJRR and 1.50 (95% CI 0.91-2.45, P = .109) in DSR. The adjusted hazard ratio for revision of total shoulder arthroplasties with metal-backed glenoid components compared to all-polyethylene glenoid components was 2.54 (95% CI 1.70-3.79, P < .001) in AOANJRR and 4.1 (95% CI 1.92-8.58, P < .001) in DSR. CONCLUSION: Based on data from 2 national shoulder arthroplasty registries, we found no significant difference in risk of revision between stemmed and stemless total shoulder arthroplasties after adjusting for the type of glenoid component. We advocate that metal-backed glenoid components should be used with caution and not on a routine basis.

High rate of clinically relevant improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis.

BACKGROUND: The minimal clinically important difference (MCID) is defined as the smallest meaningful change in a health domain that a patient would identify as important. Thus, an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient. AIM: To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis. METHODS: Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital, Denmark. The patients were evaluated preoperatively and 3 months, 6 months, 12 months, and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index (WOOS), Oxford Shoulder Score (OSS) and Constant-Murley Score (CMS). The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID. Based on previous literature, MCID for WOOS, OSS, and CMS were defined as 12.3, 4.3, and 12.8 respectively. RESULTS: Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis. Mean age at the time of surgery was 66 years (range 49.0-79.0, SD: 8.3) and 65% were women. One patient was revised within the two years follow-up. The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points [95% confidence interval (95%CI): 39.7-53.3, P < 0.005] for WOOS, 18.2 points (95%CI: 15.5-21.0, P < 0.005) for OSS and 37.8 points (95%CI: 31.5-44.0, P < 0.005) for CMS. Two years postoperatively, 41 patients (87%) had an improvement in WOOS that exceeded the MCID, 45 patients (94%) had an improvement in OSS that exceeded the MCID, and 42 patients (88%) had an improvement in CMS that exceeded the MCID. CONCLUSION: Based on three shoulder-specific outcome measures we find that approximately 90% of patients has a clinically relevant improvement. This is a clear message when informing patients about their prognosis.

Dual-therapy CD34 antibody-covered sirolimus-eluting COMBO stents versus sirolimus-eluting Orsiro stents in patients treated with percutaneous coronary intervention: the three-year outcomes of the SORT OUT X randomised clinical trial.

BACKGROUND: Target lesion failure (TLF) remains an issue with contemporary drug-eluting stents. The dual-therapy sirolimus-eluting and CD34 antibody-coated COMBO stent (DTS) was designed to improve early healing. AIMS: We aimed to compare the 3-year outcomes of the DTS and the sirolimus-eluting Orsiro stent (SES) in all-comer patients treated with percutaneous coronary intervention. METHODS: The SORT OUT X trial is a prospective multicentre randomised clinical trial with a registry-based follow-up comparing DTS and SES. The primary endpoint, TLF, is a composite of cardiac death, myocardial infarction or target lesion revascularisation (TLR). RESULTS: A total of 3,146 patients were randomised to treatment with the DTS (1,578 patients) or the SES (1,568 patients). At 3 years, an intention-to-treat analysis showed that 155 patients (9.8%) who were assigned the DTS and 118 patients (7.5%) who were assigned the SES met the primary endpoint (incidence rate ratio for TLF=1.33, 95% confidence interval: 1.04-1.70; p=0.02). This difference was caused by a significantly higher TLF rate in the DTS group compared to the SES group within the first year, which was mainly explained by a higher incidence of TLR in the DTS group compared to the SES group. Of note, the TLF rates were almost identical from 1 year to 3 years in both stent groups. CONCLUSIONS: At 3 years, the SES was superior to the DTS, mainly because the DTS was associated with an increased risk of TLF within the first year but not from 1 to 3 years. CLINICALTRIALS: gov: NCT03216733.

Compact and modular autonomous surface vehicle for water research: The Naval Operating Research Drone Assessing Climate Change (NORDACC).

Research, monitoring, and management of marine and aquatic ecosystems often require surface water samples to measure biogeochemical and optical parameters. Traditional sampling with a boat and several personnel onboard can be labor-intensive and safety requirements limit sampling activities in high-risk environments. This paper describes the Naval Operating Research Drone Assessing Climate Change (NORDACC). NORDACC is an open source, light-weight, and portable autonomous surface vehicle that can acquire surface water samples while also measuring sea surface temperature and salinity for the duration of its deployment. NORDACC is ideal for operations in remote areas where resources and personnel are limited. Two sample bottles, each one liter in volume, can be filled, either at pre-programmed sampling stations or manually, using the remote control. A trimaran design provides buoyancy and stability, with hulls constructed of vacuum-formed acrylonitrile butadiene styrene (ABS) plastic. NORDACC can navigate autonomously between waypoints and features first person view capabilities for enhanced situational awareness. NORDACC's performance was validated in Aarhus Bay, Denmark, collecting multiple surface water samples in winds in excess of 8 ms-1 and steep, choppy waves.

Stemmed hemiarthroplasty with a suture collar and a common platform system for acute proximal humeral fractures.

Background: Hemiarthroplasty for acute proximal humeral fractures gives disappointing results, often due to rotator cuff insufficiency. Better tuberosity fixation might improve results. Therefore, the aim of this study was to: 1) report the outcome of a stemmed hemiarthroplasty with a common platform system and a modular suture collar; 2) compare the outcome with that of a standard stemmed hemiarthroplasty; 3) report the feasibility of revision arthroplasty with retention of the stem; and 4) to evaluate the association between tuberosity healing and functional outcome. Methods: Forty-four fractures that were deemed not suitable for nonsurgical treatment or open reduction and internal fixation were treated with the Global Unite fracture system between January 2017 and July 2019. The functional and radiographic results at 2 years were compared with the results of 44 Global Fx arthroplasties. The results of patients who had adequate healing of the greater tuberosity were compared with the results of patients who had severe malunion or nonunion (resorption). Results: Mean Oxford Shoulder Score, Constant-Murley Score, and Western Ontario Osteoarthritis of the Shoulder index was 33 (range: 10 to 48), 40 (range: 10 to 98), and 68 (range: 18 to 98) at 2 years. There were no differences in functional outcome scores or in the risk of inadequate healing of the greater tuberosity between the Global Unite and the Global Fx systems. Five (11%) patients underwent revision surgery with retention of the stem. Inadequate tuberosity healing was associated with an inferior Constant-Murley Score (mean difference: 6; 95% confidence interval: 1 to 10, P = .01) and an inferior Oxford Shoulder Score (mean difference: 9; 95% confidence interval: 1 to 16, P = .03). Conclusion: The use of stemmed hemiarthroplasty with a suture collar did not improve the healing of the greater tuberosity or the functional outcome. Five arthroplasties were revised with retention of the stem. This possibility could be arguments for using the Global Unite system when a stemmed hemiarthroplasty is used for acute proximal humeral fractures.

Low risk of postoperative ulnar nerve affection in surgically treated distal humeral fractures when the nerve is released in situ.

BACKGROUND: Adult distal humeral fractures (DHF) comprise 2%-5% of all fractures and 30% of all elbow fractures. Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures. Open reduction and internal fixation (ORIF) are often the treatment of choice, but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality. Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication. AIM: To report the risk of ulnar nerve affection after surgery for acute DHFs. METHODS: We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF, elbow hemiarthroplasty (EHA) or total elbow arthroplasty (TEA) between January 2011 and December 2019. In all cases, the ulnar nerve was released in situ without anterior transposition. We used our institutional database to review patients' medical records for demographics, fracture morphology, type of surgery and ulnar nerve affection immediately; records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up. Twenty-nine percent patients were excluded due to pre- or postoperative conditions. Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score. A total of 210 patients were eligible for interview, but 13 patients declined participation and 17 patients failed to respond. Thus, 180 patients were included. RESULTS: Mean age at surgery was 64 years (range 18-88 years); 121 (67.3%) patients were women; 59 (32.7%) were men. According to the AO/OTA classification system, we recorded 47 patients with type A3, 55 patients with type B and 78 patients with type C fractures. According to the McGowen Classification Score, mild ulnar nerve affection was reported in nine patients; severe affection, in two. A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection. In all, 111 patients were treated with arthroplasty (67 EHA, 44 TEA) of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection. No further treatment was provided. CONCLUSION: The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition, independently of the treatment provided.

Anterior interosseous nerve syndrome after shoulder arthroscopy.

A 47-year-old woman developed anterior interosseus nerve (AIN) syndrome after subacromial decompression and acromioclavicular joint resection. The operation was performed in the beach chair position and under general anaesthesia without the application of an interscalene block. Two weeks later, the patient presented with paresis of the distal interphalangeal joint of the second finger. Previous studies have proposed traction-type neuropraxia and extravasation of irrigation fluid as leading causes. Exploration and release of the AIN can be indicated if there is no improvement 3-6 months after the operation.

Arthroscopic versus open cancellous bone grafting for scaphoid delayed/nonunion in adults (SCOPE-OUT): study protocol for a randomized clinical trial.

BACKGROUND: Scaphoid non-union results in pain and decreased hand function. Untreated, almost all cases develop degenerative changes. Despite advances in surgical techniques, the treatment is challenging and often results in a long period with a supportive bandage until the union is established. Open, corticocancellous (CC) or cancellous (C) graft reconstruction and internal fixation are often preferred. Arthroscopic assisted reconstruction with C chips and internal fixation provides minimal trauma to the ligament structures, joint capsule, and extrinsic vascularization with similar union rates. Correction of deformity after operative treatment is debated with some studies favouring CC, and others found no difference. No studies have compared time to union and functional outcomes in arthroscopic vs. open C graft reconstruction. We hypothesize that arthroscopic assisted C chips graft reconstruction of scaphoid delayed/non-union provides faster time to union, by at least a mean 3 weeks difference. METHODS: Single site, prospective, observer-blinded randomized controlled trial. Eighty-eight patients aged 18-68 years with scaphoid delayed/non-union will be randomized, 1:1, to either open iliac crest C graft reconstruction or arthroscopic assisted distal radius C chips graft reconstruction. Patients are stratified for smoking habits, proximal pole involvement and displacement of > / < 2 mm. The primary outcome is time to union, measured with repeated CT scans at 2-week intervals from 6 to 16 weeks postoperatively. Secondary outcomes are Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH), visual analogue scale (VAS), donor site morbidity, union rate, restoration of scaphoid deformity, range of motion, key-pinch, grip strength, EQ5D-5L, patient satisfaction, complications and revision surgery. DISCUSSION: The results of this study will contribute to the treatment algorithm of scaphoid delayed/non-union and assist hand surgeons and patients in making treatment decisions. Eventually, improving time to union will benefit patients in earlier return to normal daily activity and reduce society costs by shortening sick leave. TRIAL REGISTRATION: ClinicalTrials.gov NCT05574582. Date first registered: September 30, 2022. Items from the WHO trial registry are found within the protocol.

Previous rotator cuff repair increases the risk of revision surgery for periprosthetic joint infection after reverse shoulder arthroplasty.

BACKGROUND: Previous studies have indicated an increased risk of periprosthetic joint infection (PJI) in patients treated with reverse shoulder arthroplasty (RSA) compared with patients treated with anatomic total shoulder arthroplasty. The reason for this is unclear but may be related to a high prevalence of previous rotator cuff repair in patients who are treated with RSA. The purpose of this study was to determine previous non-arthroplasty surgery as a risk factor for revision owing to PJI after RSA for cuff tear arthropathy, massive irreparable rotator cuff tears, or osteoarthritis. METHODS: Data were retrieved from the Danish Shoulder Arthroplasty Registry and medical records. We included 2217 patients who underwent RSA for cuff tear arthropathy, massive irreparable rotator cuff tears, or osteoarthritis between 2006 and 2019. PJI was defined as ≥3 of 5 tissue samples positive for the same bacteria or as definite or probable PJI evaluated based on criteria from the International Consensus Meeting. The Kaplan-Meier method was used to illustrate the unadjusted 14-year cumulative rates of revision. A Cox regression model was used to report hazard for revision owing to PJI. Results were adjusted for previous non-arthroplasty surgery, sex, diagnosis, and age. RESULTS: Revision was performed in 88 shoulders (4.0%), of which 40 (1.8%) underwent revision owing to PJI. There were 272 patients (12.3%) who underwent previous rotator cuff repair, of whom 11 (4.0%) underwent revision owing to PJI. The 14-year cumulative rate of revision owing to PJI was 14.1% for patients with previous rotator cuff repair and 2.7% for patients without previous surgery. The adjusted hazard ratio for revision owing to PJI for patients with previous rotator cuff repair was 2.2 (95% confidence interval, 1.04-4.60) compared with patients without previous surgery. CONCLUSION: There is an increased risk of revision owing to PJI after RSA for patients with previous rotator cuff repair. We recommend that patients with previous rotator cuff repair be regarded as high-risk patients when considering RSA.

Short-term survival and patient-reported outcome of total stemless shoulder arthroplasty for osteoarthritis are similar to that of stemmed total shoulder arthroplasty: a study from the Danish Shoulder Arthroplasty Registry.

Background: The use of stemless total shoulder arthroplasty (TSA) for osteoarthritis increases, but there is a paucity on its safety and efficacy and how it performs in comparison with stemmed TSA. The aim was to compare the 5-year cumulative survival rate and patient-reported outcome after stemless and stemmed TSA for osteoarthritis. Methods: We included all stemmed (n = 1197) and stemless (n = 253) TSA for osteoarthritis reported to the Danish shoulder arthroplasty registry from January 1, 2014, to December 31, 2018. Results: Six (2.4%) stemless and 24 (2%) stemmed TSA were revised. The 5-year cumulative implant survival rates were 0.96 for stemless TSA and 0.97 for stemmed TSA. In the multivariate Cox regression model, the hazard ratio for revision was 1.1 (95% confidence interval, 0.5-2.6) for stemless TSA compared with stemmed TSA. The mean Western Ontario Osteoarthritis of the Shoulder (WOOS) index was 82 (standard deviation = 21) for stemmed and 86 (standard deviation = 19) for stemless TSA. The stemless TSA had a statistically significant better WOOS compared with stemmed TSA, but the difference of 6.2 (95% confidence interval, 1.4-10.4) was not regarded as clinically relevant. There was no difference in WOOS between the Nano and the Eclipse systems. Discussion: We found a good 5-year cumulative implant survival rate of stemless TSA, which was comparable with stemmed TSA. Although the stemless TSA had a statistically significant better patient-reported outcome compared with stemmed TSA, the difference was not clinically relevant. Sparing the humeral shaft canal for later revision could be an argument for using stemless TSA instead of stemmed TSA.

Elbow hemiarthroplasty vs. open reduction internal fixation for acute Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type 13C fractures-A systematic review.

Background: Open reduction and internal fixation (ORIF) is the standard treatment for multifragmentary intra-articular distal humeral fractures. Fractures not amenable by ORIF are treated with total elbow arthroplasty (TEA). In recent years, elbow hemiarthroplasty (EHA) has been used as an alternative to TEA, as weight bearing restrictions and risk of component loosening are lower. We systematically reviewed the literature reporting functional outcomes and complication rates after either EHA or ORIF for Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type 13C fractures. Methods: We searched PubMed, Embase, The Cochrane Library, and Scopus. The inclusion criteria were at least 5 patients, aged ≥50 years, AO/OTA type 13C fracture treated with ORIF or EHA, and evaluation with the Mayo Elbow Performance Score. Literature screening and data extraction were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The results were synthesized qualitatively using weighted means. No comparative statistical analyses were done. Results: We included 27 articles, which included 96 patients treated with EHA and 535 patients treated with ORIF. We identified 1 randomized controlled trial and 26 case series. The weighted mean Mayo Elbow Performance Score was 86.9 (n = 89) in the EHA group and 84.7 (n = 535) in the ORIF group. There were 26 (33%) complications (n = 78) in the EHA group and 103 (38%) complications (n = 270) in the ORIF group. Complication rates were generally high in both groups. Conclusion: We found comparable results of EHA and ORIF, which indicate that EHA is a viable treatment option for AO/OTA type 13C fractures not amenable by ORIF. Because of high risk of bias, interpretation of the results should be done with caution.

Implant migration and functional outcome of Reverse Shoulder Lateralized Glenosphere Line Extension System: a study protocol for a randomized controlled trial.

BACKGROUND: Inferior scapular notching is a complication unique to reverse shoulder arthroplasty. The most efficient technique to avoid inferior scapular notching has been reported to be lateralization of the glenoid offset. This study aims to compare radiological and functional outcomes of the DELTA Xtend® Reverse Shoulder System Lateralized Glenosphere Line Extension (intervention group) with the Standard DELTA Xtend® Reverse Shoulder System (control group). We hypothesize that the lateralization improves the patient outcome by decreasing the risk of inferior scapular notching without increasing the risk of migration and loosening of glenoid component. METHODS: In this randomized controlled trial, all Danish citizens with rotator cuff arthropathy or degeneration of the glenohumeral joint with severe posterior wear and allocated for a reverse total shoulder arthroplasty at the department of orthopaedic surgery at Herlev and Gentofte Hospital, Copenhagen University Hospital, will be considered for participation. The exclusion criteria are as follows: below 50 years of age, cognitive or linguistic impairment, insufficient glenoid bone stock, previous fracture in the upper extremity and autoimmune-mediated inflammatory arthritis. There will be included a total of 122 patients of which 56 will participate in the radiostereometric analysis. This number of patients allows 20% to drop out. The co-primary outcomes are the pattern and magnitude of the migration of the glenoid component assessed by radiostereometric analysis and the Western Ontario Osteoarthritis of the Shoulder index. The secondary outcomes are inferior scapular notching, patient-reported and functional outcomes (Oxford shoulder score, Constant-Murley score and pain), side effects and complications, changes in bone mineral density and economy. The included patients will be examined before the surgery, within 1 week and 3, 6, 12 and 24 months after. DISCUSSION: No previous studies have compared the conventional reverse shoulder arthroplasty with the lateralized reverse shoulder arthroplasty in a randomized controlled trial regarding migration and functional outcome. Furthermore, radiostereometric analysis has not been used to evaluate the migration of reverse shoulder arthroplasty in a randomized controlled trial. This study intends to determine which treatment has the most optimal outcome for the benefit of future patients with an indication for reverse shoulder arthroplasty. TRIAL REGISTRATION: The study has been notified to Pactius and has approval number P-2021-231. Furthermore, the study will be registered on Clinicaltrials.gov before starting the inclusion.