Stemless reverse total shoulder arthroplasty: a systematic review.

BACKGROUND: The use of reverse total shoulder arthroplasty and stemless anatomic total shoulder replacement has been increasing in the United States every year. Stemless humeral components in reverse total shoulder arthroplasty are only approved for clinical trials in the United States with an investigational device exception with limited data. METHODS: A systematic review on stemless reverse total shoulder arthroplasty was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search was conducted on November 25, 2020, using the MEDLINE/PubMed, Cochrane, and Embase databases. All articles were reviewed by 2 independent evaluators, with any conflicts or issues resolved by consensus or a final decision by the senior author. The primary outcomes extracted were complications, radiographic results, and outcome scores. RESULTS: We evaluated 10 studies that used either the Total Evolutive Shoulder System (TESS) or Verso implant. There were 430 total patients and 437 total procedures; 266 patients in the TESS group underwent a total of 272 procedures, and 164 patients in the Verso group underwent a total of 165 procedures. The mean age at the time of surgery was 73.8 years (range, 38-93 years). The mean follow-up period ranged from 6.4 to 101.6 months per study. There was an overall trend of improved clinical outcome scores, a 0.2% humeral component loosening rate, and an 11.2% complication rate. CONCLUSIONS: This review shows that the clinical and functional outcomes following stemless or metaphyseal reverse total shoulder arthroplasty are quite promising, especially with the low rate of humeral-sided complications. There continues to be a need for additional long-term studies and randomized clinical trials.

The Quality and Accuracy of Online Resources for Total and Reverse Shoulder Replacement.

Recent literature suggests that many online patient resources are poor in quality and lack important clinical information. The purpose of this study was to investigate the value of online resources available to patients considering shoulder arthroplasty. A total of 84 websites were discovered with the terms "total shoulder replacement" (TSR) and "reverse shoulder replacement" (RSR), they were reviewed and graded for quality and accuracy. Overall quality scores were low for TSR and RSR websites, 22.8/45 (95% confidence interval (CI): 19.9-25.6) and 24.2/45 (95% CI: 21.6-26.9), respectively. The authorship of a website significantly influenced the quality for both TSR (p = 0.013) and RSR (p = 0.048). When comparing search rank to quality scores, websites that appeared earlier demonstrated significantly higher quality scores, TSR (p = 0.017) and RSR (p = 0.018). Overall, most websites were accurate but provided incomplete information. Websites authored by professional societies have higher quality scores than websites authored by medical providers or commercial entities. (Journal of Surgical Orthopaedic Advances 28(4):290-294, 2019).

Radiographic evaluation of humeral head reconstruction with stemmed and stemless spherical implants compared with stemless elliptical head implants.

BACKGROUND: The purpose of this study was to compare the accuracy of anatomic reconstruction of three different humeral head designs after anatomic total shoulder arthroplasty. METHODS: Postoperative radiographs of 117 patients who underwent anatomic total shoulder arthroplasty with three different implant designs (stemmed spherical, stemless spherical, and stemless elliptical) were analyzed for landmarks that represented the prearthritic state and final implant position. We assessed the change in center of rotati7on and humeral head height on the anteroposterior view and the percentage of prosthesis overhang on the axillary lateral view. A modified anatomic reconstruction index, a compound score that rated each of the 3 parameters from 0 to 2, was created to determine the overall accuracy of the reconstruction. RESULTS: Excellent modified anatomic reconstruction index scores (5 or 6 points) were achieved by 68.1% of the cases in the stemless elliptical group compared with 33.3% of the cases in the stemless spherical group and by 28.3% of the cases in the stemmed spherical group (P = .001).The mean difference in restoration of humeral head height (P < .001) and percentage of prosthesis overhang (P < .001) was superior for the stemless elliptical group compared with the two other spherical head groups. There was no difference between groups for the shift in center of rotation (P = .060). CONCLUSIONS: In this radiographic investigation comparing three different humeral head designs with respect to anatomic restoration parameters, the stemless elliptical implant more closely restored the geometry of the prearthritic humeral head as assessed by humeral head height, prosthesis overhang, and a compound reconstruction score.

Baseplate Options for Reverse Total Shoulder Arthroplasty.

PURPOSE OF REVIEW: Baseplate fixation has been known to be the weak link in reverse total shoulder arthroplasty (RTSA). A wide variety of different baseplates options are currently available. This review investigates the recent literature to present the reader with an overview of the currently available baseplate options and modes of fixation. RECENT FINDINGS: The main elements that differentiate baseplates are the central fixation element, the size of the baseplate, the shape, the backside geometry, whether or not an offset central fixation exists, the number of peripheral screws, and the availability of peripheral augmentation. The wide array of baseplate options indicates that no particular design has proven superiority. As such, surgeons should be aware of their options and choose an implant that the surgeon is comfortable with and one that best suits the individual patient anatomy. With the growing number of RTSA procedures and registries with long-term follow-up, future investigations will hopefully delineate the ideal baseplate design to optimize survivorship.

Outpatient narcotic consumption following total shoulder arthroplasty.

INTRODUCTION: In the setting of the opioid epidemic, physicians continue to scrutinize ways to minimize exposure to narcotic medications. Several studies emphasize improvements in perioperative pain management following total shoulder arthroplasty (TSA). However, there is a paucity of literature describing outpatient narcotic consumption requirements following TSA. METHODS: A single-institution, prospective study of patients undergoing primary TSA was performed. Preoperative demographics including exposure to narcotics, smoking history, and alcohol exposure were collected. The primary outcome was measurement of total outpatient narcotic consumption 6 weeks from surgery. Narcotic consumption was verified by counting leftover pills at the final follow-up visit. RESULTS: Overall, 50 patients were enrolled. The median narcotic consumption in the cohort was 193 morphine equivalent units (MEUs), approximately 25 (5-mg) tablets of oxycodone, and the mean consumption was 246 MEUs, approximately 32 (5-mg) tablets. Almost 25% of patients consumed fewer than 10 total tablets, with 10% of patients taking no narcotics at home. Multivariate regression found preoperative narcotic exposure associated with increased consumption of 31 MEUs (P = .004). Older age was found to be protective of narcotic consumption, with increasing age by 1 year associated with 0.75 MEU decrease in consumption (P = .04). CONCLUSIONS: Anatomic total shoulder arthroplasty in general provides quick, reliable pain relief and does not require a significant amount of narcotic medication postoperatively. For most patients, it is reasonable to prescribe the equivalent of 25-30 (5-mg) oxycodone tablets following TSA.

Anterior versus posterior approach total hip arthroplasty: patient-reported and functional outcomes in the early postoperative period.

PURPOSE: Direct anterior approach total hip arthroplasty (DA THA) has been reported to improve early outcomes compared to posterior approach THA up to 6 weeks postoperatively. Limited weekly outcomes data are available prior to 6 weeks. We evaluate outcomes including when patients first drive a car, leave home, and discontinue their assist device. METHODS: Patients undergoing THA for primary osteoarthritis were prospectively enrolled. Outcomes data were collected preoperatively and postoperatively at weekly intervals for 6 weeks. RESULTS: 111 patients (55 DA and 56 posterior approach) were enrolled. There was no significant difference (p > 0.05) in pre-surgical Patient-Reported Outcomes Measurement Information System (PROMIS) scores or modified Harris Hip Score (mHHS).Postoperatively, the DA THA group had decreased length of stay (p = 0.0002) and increased distance walked on postoperative day 1 and 2 (p = 0.011, p = 0.0004). The DA group had lower pain scores (p < 0.05) and required less day 1 and total narcotics (p = 0.029, p = 0.01). The DA cohort had improved PROMIS Physical Function scores and mHHS up to 5 weeks postoperatively. DA patients discontinued their assistive device 8 days earlier (p = 0.01), left home 3 days earlier (p = 0.001), and drove a car 5 days earlier (p = 0.01). CONCLUSIONS: Patients undergoing DA THA discontinued their assistive device, left their home, and drove a car sooner than posterior approach patients. We found improvement in physical function with DA, and it persisted up to 5 weeks postoperatively. Furthermore, DA patients had significantly shorter length of stay, improved mobilisation, decreased narcotic requirements and improved inpatient pain scores compared to posterior approach THA. Future randomised controlled study should be performed to minimise the biases inherent in this study methodology and confirm the results.

Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic.

Orthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sport medicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.