Short-term outcomes of reverse shoulder arthroplasty using a custom baseplate for severe glenoid deficiency.

HYPOTHESIS AND BACKGROUND: Complex glenoid bone loss and deformity present a challenge for the shoulder arthroplasty surgeon. Eccentric reaming, bone grafting, augmented glenoid components, and salvage hemiarthroplasty are common strategies for managing these patients. The glenoid vault reconstruction system (VRS; Zimmer-Biomet) is a novel solution for both primary and revision arthroplasty using a custom glenoid baseplate. We hypothesized that patients undergoing reverse shoulder arthroplasty (RSA) with VRS would have acceptable short-term outcomes and complication rates. METHODS: Patients who underwent RSA with VRS for severe glenoid deformity or bone loss by one of 4 board-certified, fellowship-trained shoulder and elbow surgeons at 3 academic tertiary referral centers between September 2015 and November 2018 were eligible for inclusion. Patient data were obtained via medical record review and telephone questionnaires. The Numeric Pain Rating Scale (NPRS), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Penn Shoulder Scores, and range of motion (ROM) measurements were obtained pre- and postoperatively. Radiographs were reviewed at final follow-up for evidence of component loosening or hardware failure. Any complication was documented. Outcomes were compared using Wilcoxon signed-rank tests with P <. 05 considered significant. RESULTS: Twelve shoulders (11 patients) were included with a mean age of 68 years; 7 were primary arthroplasties and 5 were revisions. At an average follow-up time of 30 months, median improvement in NPRS score was 7 points, SANE score 43%, ASES score 45 points, and Penn Shoulder Score 49 points. There were statistically significant improvements in median ROM measurements (forward elevation 20°, external rotation 40°, internal rotation 2 spinal levels). At final follow-up, all implants were radiographically stable without loosening. There were no complications. DISCUSSION AND CONCLUSION: This study demonstrates that RSA using the custom VRS glenoid implant is a safe and effective technique addressing complex glenoid deformity or bone loss in both primary and revision settings. At short-term follow-up, all patient-reported outcomes and ROM measures improved significantly, and there were no complications. Future work should determine mid- and long-term outcomes, preferably in a prospective manner with defined patient populations.

Analysis of the Perception and Treatment of Osteoarthritis of the Knee Through Social Media: An Observational Study of the Top 100 Viral TikTok Videos.

BACKGROUND:  TikTok is a popular platform that can be used for medical insights. However, spreading inaccurate information about diagnosing or treating medical conditions can undermine the quality of patient care. Our assessment focused on the discourse surrounding knee osteoarthritis on TikTok, with two primary objectives: 1) identifying the creators behind osteoarthritis-related content, and 2) examining whether a connection exists between the reach of video content and the strength of recommendations provided. METHODS:  The top 100 TikTok videos were chosen based on likes on March 29, 2023. Posts were identified using the hashtag ("#Osteoarthritis"). Videos were classified by the following: number of likes, comments, shares, date of upload, uploader (medical professional, non-medical professional, or business), and video content (medical treatment, home remedy, personal story). Treatments were rated according to the American Academy of Orthopaedic Surgeons (AAOS) Evidence-Based Clinical Practice Guideline for Osteoarthritis using the strength of evidence criteria (1-4 stars). Descriptive and univariate analyses were performed. RESULTS:  Among the top videos, 67.7% were uploaded by medical professionals. Private companies, despite having the highest average likes (29,681.2) and shares (1,367.5) per video, had a limited average evidence strength of 2.13. Physician-created videos had the second-highest average number of likes (25,440.1) and shares (1,224.5) per video with a strength of evidence of 3.03. Non-medical professional videos had the lowest evidence support (0.89). Medical treatments, the most liked and shared content, had the lowest evidence strength (1). There was no statistically significant correlation between the number of likes (p=0.808), comments (p=0.647), or shares (p=0.439) to the strength of evidence regarding the intervention. DISCUSSION:  TikTok can be unreliable for knee osteoarthritis treatment information. It is common to find non-physicians sharing medical advice on the platform, with medical treatments demonstrating the weakest level of supporting evidence. Orthopaedic surgeons should advise their patients that TikTok treatment recommendations may not align with established guidelines.

Where to tenodese the biceps: proximal or distal?

BACKGROUND: The best location for biceps tenodesis is controversial as surgeons have begun to question whether tenodesis location affects the incidence of residual bicipital postoperative pain. An open distal tenodesis technique has been previously proposed to eliminate remaining symptoms at the bicipital groove. QUESTIONS/PURPOSES: We asked the following questions: (1) Does a higher tenodesis in the biceps groove result in postoperative pain? And (2) can the tenodesis location be successfully moved more distally ("suprapectoral tenodesis") by an arthroscopic technique? METHODS: We retrospectively reviewed 17 patients undergoing arthroscopic biceps tenodesis and evaluated their tenodesis location, either within the upper half of the groove (five) or in the lower half of the groove or shaft (12). Patient outcomes were assessed with visual analog scale scores for pain, American Shoulder and Elbow Surgeons scores, and Constant-Murley scores. Minimum followup was 12 months (mean, 28 months; range, 12-69 months). RESULTS: Two patients had persistent pain at 12 months; both had a tenodesis in the upper half of the groove. The overall American Shoulder and Elbow Surgeons and Constant-Murley scores were improved at latest followup. CONCLUSIONS: Arthroscopic suprapectoral biceps tenodesis represents a new technique for distal tenodesis. Our preliminary observations suggest a more distal tenodesis location may decrease the incidence of persistent postoperative pain at the bicipital groove, although additional research is needed to definitively state whether the proximal location is in fact more painful. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Reliability and accuracy of templating the proximal humeral component for shoulder arthroplasty.

BACKGROUND: The purpose of this paper is to examine the intra-observer and inter-observer reliability of preoperative templating to help determine its usefulness for approximating proximal humeral stem and head size in shoulder arthroplasty. METHODS: Thirty-one nonconsecutive patients underwent uncemented total shoulder arthroplasty using 1 of 2 commonly used prostheses. Templating was performed by 4 independent observers (2 experienced shoulder surgeons and 2 PGY-3 residents). Two readings were performed with a minimum 2-week interval between templating sessions. Templating was performed in a blinded manner using appropriately magnified templates provided by the prosthesis manufacturer. Postoperative radiographs were analyzed in the same fashion and each observer graded qualitative stem and head size radiographically. Pre-operative templated sizes were compared to actual implant sizes obtained from dictated operative reports. RESULTS: There was substantial (kappa > 0.7) intraobserver reliability for stem and head size selection for both prostheses. Interobserver reliability was moderate for stem size (kappa = 0.53) and substantial (kappa = 0.66) for head size. Preoperative templating accurately predicted stem (84-95%) and head (44-66%) size within 1 size variation (stem width, head thickness, or diameter) for shoulder replacement surgery. There was no significant difference in accuracy between attendings and residents when templating for stem or head size. CONCLUSION: Preoperative templating is a reliable and reasonably accurate step when planning shoulder replacement surgery. Templating for stem size is more accurate than for head size.