BACKGROUND:Although international guidelines recommend that patients be trained in emergency self-disconnection procedures from the dialysis machine, little is known about patients' knowledge and procedural accuracy regarding this practice. OBJECTIVE:This study aimed to evaluate the knowledge of people receiving haemodialysis and their ability to correctly identify the steps required to disconnect themselves from the dialysis machine in an emergency, safely. METHODS:This international multicentre descriptive study was conducted between September 2025 and January 2026 in 10 dialysis centres across six countries: Türkiye, Denmark, Greece, Portugal, Poland and Peru. Adult patients receiving maintenance haemodialysis for at least 3 months were eligible to participate. Data were collected using a participant information form and a self-disconnection checklist consisting of two sections evaluating preparation knowledge and procedural steps. Descriptive statistics were used to summarise the data. RESULTS:Of the 626 people receiving haemodialysis included in the study, 125 (20.0%) had received training on self-disconnection from the dialysis machine (Türkiye, Peru, Greece, and Denmark). Overall, 22.4% of patients reported knowing how to disconnect themselves from the dialysis machine in an emergency. According to the checklist evaluation, 40.3% of patients correctly identified the first stage of the procedure, and 38.3% correctly identified the second stage. CONCLUSION:A substantial gap exists between perceived knowledge and actual procedural competence regarding emergency self-disconnection among people receiving haemodialysis. These findings highlight the need for structured education, simulation-based training and standardised protocols to improve disaster preparedness and patient safety in dialysis units. CLINICALTRIALS:gov: NCT07412834.
BACKGROUND:Arteriovenous fistula is a vascular access commonly used for long-term haemodialysis because of its durability and lower complication rate. Adequate self-care is essential, as poor self-care may lead to thrombosis, infection, and early access failure. Currently, Indonesia lacks a validated instrument to measure specific self-care behaviours. OBJECTIVE:This study aims to adapt and translate the Assessment of Self-Care Behaviours with Arteriovenous Fistula instrument into Indonesian and to evaluate its psychometric properties among patients receiving haemodialysis in Indonesia. DESIGN:Cross-sectional validation study. PARTICIPANTS:This study included 160 patients undergoing haemodialysis using an arteriovenous fistula. MEASUREMENT:The cross-cultural adaptation process followed internationally recognised guidelines. Content validity was evaluated by experts using the Item Content Validity Index and Scale Content Validity Index. Construct validity was examined using Exploratory Factor Analysis. Reliability testing was conducted using Cronbach's α coefficient. RESULTS:All 16 items demonstrated satisfactory content validity. The Kaiser-Meyer-Olkin value was 0.815, and Bartlett's test was significant (p < 0.001), confirming data suitability for factor analysis. Exploratory factor analysis identified a two-factor structure explaining 55.04% of the total variance, representing management of signs and symptoms and prevention of complications. The overall scale showed excellent internal consistency (α = 0.902), with α values of 0.902 and 0.833 for Factors 1 and 2, respectively. CONCLUSIONS:The Indonesian version of the Assessment of Self-Care Behaviours with Arteriovenous Fistula scale is valid and reliable in assessing self-care behaviours among patients receiving haemodialysis with arteriovenous fistula in Indonesia.
BACKGROUND:Fatigue is common and debilitating in adults undergoing haemodialysis, significantly impairing health-related quality of life. Non-pharmacological interventions such as self-management education, exercise training, and cognitive behavioural therapy have been shown to reduce fatigue in this population. However, a comprehensive quantitative synthesis of their overall effectiveness is still lacking. OBJECTIVES:To evaluate the efficacy of self-management education, exercise training, and cognitive behavioural therapy in reducing fatigue among adults receiving haemodialysis. DESIGN:Systematic review with meta-analysis. PARTICIPANTS:Adults receiving haemodialysis. MEASUREMENTS:Nine databases were searched from inception to 27 January, 2026. Randomised controlled trials and quasi-experimental studies were included. Study quality was appraised using the Joanna Briggs Institute critical appraisal tools. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Meta-analyses were conducted using R (version 4.4.1), with pooled effects reported as standardised mean differences based on change scores. RESULTS:Thirty studies were included. Self-management education demonstrated a significant effect on fatigue (SMD = 0.98, 95% CI [0.69, 1.28], p < 0.001, moderate certainty evidence). Exercise training also yielded a significant benefit (SMD = 0.82, 95% CI [0.44, 1.20], p < 0.001, low certainty evidence). Cognitive behavioural therapy did not show a significant effect (SMD = 1.45, 95% CI [-0.46, 3.37], p = 0.137, very low certainty evidence). CONCLUSIONS:Self-management education may be considered for routine clinical care, while exercise training may serve as an adjunctive strategy. The efficacy of cognitive behavioural therapy remains inconclusive. Further high-quality trials are needed.
Background:The optimal surgical management of displaced proximal humerus fractures in elderly patients remains controversial. Reverse total shoulder arthroplasty (rTSA) has gained increasing acceptance for complex fracture patterns, yet comparative data against open reduction and internal fixation (ORIF) across age strata are limited. This study compared reoperation rates, emergency department (ED) utilization, and dislocation following rTSA versus ORIF in propensity score-matched cohorts stratified by age. Methods:Using the TriNetX multi-institutional research network, patients aged 65-74 years and 75-84 years who underwent rTSA or ORIF for proximal humerus fractures were identified. Propensity score matching was performed using nearest-neighbor matching with a 0.150 standard deviation caliper. The primary outcome was coded shoulder-related return to surgery at 1 and 2 years. Secondary outcomes included all-cause ED utilization and coded dislocation when available. Results:After matching, 748 patients (374 per group) were analyzed in the 65 to 74-year cohort and 882 patients (441 per group) in the 75 to 84-year cohort. Patients undergoing rTSA had significantly more 4-part fractures (34.2% vs. 6.4% in the 65 to 74-year cohort, P < .001). At 2-year follow-up, reoperation rates did not differ significantly in either age group (65-74 years: rTSA 5.62% vs. ORIF 3.48%, risk ratio 1.62, P = .16; 75-84: rTSA 4.54% vs. ORIF 5.67%, risk ratio 0.80, P = .444). Kaplan-Meier survival analysis confirmed no significant differences in freedom from surgical failure. ED utilization did not differ significantly between groups, and dislocation was comparable in the 75 to 84-year cohort for which dislocation data were available. Conclusion:In propensity score-matched cohorts, rTSA and ORIF demonstrated comparable coded reoperation rates and all-cause ED utilization at 1- and 2-year follow-up. These findings persisted despite rTSA patients having more complex fracture patterns; however, because fracture morphology and patient-reported outcomes were not directly matched or captured, the results should be interpreted as hypothesis-generating real-world associations rather than evidence of treatment superiority.
BACKGROUND:People receiving in-centre haemodialysis have distinct cultural care needs and preferences, and nurses are expected to respond to these. However, haemodialysis nurses' cultural competence and responsiveness are unknown. OBJECTIVES:To examine nurses' cultural competence and responsiveness when caring for people with diverse cultural characteristics. DESIGN:An online cross-sectional survey. PARTICIPANTS:Haemodialysis nurses from Australia and New Zealand (n = 123), recruited through the Renal Society of Australasia and professional networks. MEASUREMENTS:The 25-item Cultural Competence Assessment instrument measured cultural awareness and sensitivity, and culturally responsive behaviours. Demographic characteristics were also collected. RESULTS:Of 123 complete responses, overall cultural competence was high (M = 5.09, SD = 0.76), particularly awareness and sensitivity (M = 5.76, SD = 0.53), with significantly higher scores among those who had completed cultural awareness training (p = 0.009). In contrast, culturally responsive behaviours were moderate (M = 4.53, SD = 1.23), highlighting the gap between cultural competence and responsiveness. The lowest scoring areas were documentation of patients' cultural needs (M = 3.88, SD = 2.02) and access to cultural learning resources (M = 3.02, SD = 1.75), indicating limited supports. Qualitative findings reflected practices of culture care preservation and accommodation, with themes of cultural awareness and language differences highlighting barriers related to language and resources. CONCLUSIONS:High cultural competence does not necessarily translate into culturally responsive behaviour. Organisational supports, including guidance for documenting cultural needs, cultural assessment tools and accessible learning resources, may help strengthen culturally responsive haemodialysis care.
Background:The optimal implant selection for patients with rotator cuff-intact primary glenohumeral osteoarthritis remains controversial, particularly with respect to patient age. Although reverse total shoulder arthroplasty (rTSA) has been increasingly utilized in older patients, it is unclear whether chronological age alone modifies the relative effectiveness of anatomic total shoulder arthroplasty (aTSA) versus rTSA when baseline characteristics are adequately controlled. Methods:This retrospective comparative study included patients with rotator cuff-intact primary glenohumeral osteoarthritis who underwent aTSA or rTSA with a minimum follow-up of 3 years. Propensity score matching was performed in a 1:1 ratio to minimize baseline differences between groups, including age, sex, pre-operative clinical outcomes, range of motion, and rotator cuff muscle quality assessed by fatty infiltration. Clinical outcomes were compared using the American Shoulder and Elbow Surgeons (ASES) score as the primary outcome measure. Secondary outcomes included the Constant score, Single Assessment Numeric Evaluation, and post-operative range of motion (forward elevation, external rotation, and internal rotation), as well as complications including scapular notching and acromial or scapular spine stress fracture in the rTSA group and glenoid loosening or rotator cuff failure in the aTSA group. Age-based subgroup analyses (≤70 years vs. > 70 years) and age-procedure interaction analyses were conducted to evaluate whether age modified the association between implant type and outcomes. Results:After matching, 44 well-balanced pairs (88 patients) were identified. There were no significant differences between the aTSA and rTSA groups in post-operative ASES scores or secondary clinical outcomes. Age-stratified analyses demonstrated consistent results across both age groups, and no significant age-procedure interaction effects were observed. From a clinical perspective, both procedures achieved post-operative ASES and Constant scores exceeding established minimal clinically important difference thresholds. Although the overall complication rate was numerically higher in the rTSA group, these events were predominantly procedure-specific and were largely managed with conservative treatment. Revision rates were low and comparable between groups. Conclusion:When baseline characteristics are adequately balanced, aTSA and rTSA provide comparable short-term to midterm clinical outcomes in patients with rotator cuff-intact primary glenohumeral osteoarthritis. Chronological age alone does not appear to modify the relative effectiveness of implant type, suggesting that implant selection should be guided by rotator cuff integrity, glenoid morphology, and patient-specific functional demands rather than age alone.
Background:Aseptic loosening of on-lay all-polyethylene cemented glenoid components in total shoulder arthroplasty is a leading cause of revision surgery and may be accelerated by the rocking-horse phenomenon. In response to this, inset glenoid implants have been developed in hopes that they will lead to lower loosening rates. Presently, little literature exists on the ideal depth of insetting to minimize micromotion while also considering glenoid bone preservation. This study, therefore, evaluated a generic circular inset glenoid component implanted at 4 depths in osteoarthritic glenoids using finite element models. Micromotion under simulated joint loading, bone removal, and underlying bone density were compared. The goal was to determine an optimal inset depth that minimizes micromotion while preserving glenoid bone. Methods:Finite element models of 7 male osteoarthritic scapulae were generated from pre-operative computed tomography scans. Circular inset glenoid components were virtually implanted at 4 depths: 25%, 50%, 75%, and 100% (inlay). Glenohumeral joint loading was simulated in 5 directions. Tangential (parallel) and normal (perpendicular) micromotions were measured across 6 backside regions of the component for each loading direction. The volume of bone removed for implantation and bone density within a 5-mm depth region beneath each component were also evaluated. Results:No significant relationship was found between inset depth and tangential micromotion across load directions or locations (P > .05). The 25% depth showed the greatest median tangential micromotion in 12 of 42 cases (29%), the 50% and 100% depths in 11 cases each (26%), and the 75% depth in 8 cases (19%). Similarly, no significant relationship was observed between inset depth and normal micromotion. The 25% depth had the greatest median normal micromotion in 15 of 42 cases (36%), followed by 75% in 13 cases (31%), 50% in 8 cases (19%), and 100% in 6 cases (14%).Bone removal increased significantly with increasing inset depth (P < .05). On average, the 100% depth required approximately 4 times more bone removal than the 25% depth. Bone density within the 5-mm depth region beneath the component was highest at the 25% depth. Significant differences were observed between the 25% depth and the 50% (P = .03), 75% (P = .03), and 100% depths (P = .049), while no significant differences were found among the deeper depths. Conclusion:Inset depth was not significantly associated with glenoid component micromotion, although a trend toward reduced micromotion with greater depth was observed. However, deeper insetting required substantially more bone removal and was associated with lower underlying bone density. Considering implant stability, bone preservation, and supporting bone density, these findings support glenoid component insetting at approximately 25-50% depth.
BACKGROUND:Chronic Kidney Disease-associated Pruritus is a chronic itching condition experienced by patients during and between dialysis sessions. The individualised nature of the condition makes prevalence and severity difficult to measure. OBJECTIVES:The study aimed to identify the prevalence of Chronic Kidney Disease-associated Pruritus amongst patients receiving dialysis in Ireland, characterise symptom burden, severity, and frequency, factors associated with worsening symptoms, and to examine patient experiences of itching. DESIGN:A quantitative study with a qualitative free-text element was employed. PARTICIPANTS:689 patients undergoing dialysis completed a national survey. MEASUREMENTS:Patients undergoing haemodialysis and peritoneal dialysis completed the 5-D itch scale and a qualitative assessment of itching experiences. Regression analyses examined associations between domains of the 5-D itch scale, patient clinical characteristics and the occurrence of moderate-severe itching. Content analysis was used to report qualitative findings. RESULTS:Sixty-two percent (85% haemodialysis; 15% peritoneal dialysis) experienced Chronic Kidney Disease-associated Pruritus; 66% reported moderate-severe itching, with body/trunk region most affected (73%); however, the scalp/face region was most associated with moderate-severe itching (OR = 2.08, 95% CI 1.11-3.870). Four themes were identified: (1) the physical impact of Chronic Kidney Disease-associated Pruritus; (2) the psychological burden of itching; (3) variability in treatment success; (4) itch resolving over time. CONCLUSION:Two-thirds of Irish patients experience moderate-severe Chronic Kidney Disease-associated Pruritus; a prevalence rate higher than international estimates. This condition is psychologically distressing - impacting sleep, overall quality of life, and risk of infection. Patients require improved clinical attention and greater pratitioner education on management of this condition.
BACKGROUND:Regular exercise is recommended for patients undergoing haemodialysis; however, participation rates remain low in Japan. Perceived benefits and barriers are key cognitive determinants of exercise behaviour, yet no validated instrument exists to assess these perceptions among Japanese patients receiving haemodialysis. OBJECTIVES:Translate and culturally adapt the Dialysis Patient-Perceived Exercise Benefits and Barriers Scale into Japanese and evaluate its psychometric properties. DESIGN:A methodological study. PARTICIPANTS:In total, 150 adults undergoing maintenance haemodialysis were recruited from facilities across Japan. MEASUREMENTS:Structural validity was examined using exploratory and confirmatory factor analyses. Concurrent validity was assessed through correlations with physical activity levels measured using the International Physical Activity Questionnaire. Known-groups validity was evaluated by comparing scale scores between participants with and without exercise habits. Reliability was assessed using internal consistency and item-total correlations. RESULTS:Confirmatory factor analysis supported the original six-factor structure with acceptable model fit (CFI = 0.922, TLI = 0.910, RMSEA = 0.055 and SRMR = 0.062). The Japanese version showed moderate concurrent validity with physical activity levels (Spearman's r = 0.379, p < 0.01) and discriminated between participants with and without exercise habits (p < 0.001). Internal consistency was excellent (Cronbach's α = 0.901), and all item-total correlation coefficients exceeded acceptable thresholds. CONCLUSIONS:The Japanese version of the Dialysis Patient-Perceived Exercise Benefits and Barriers Scale is a reliable and valid instrument for assessing exercise-related perceptions among patients receiving haemodialysis in Japan. This tool may facilitate individualised exercise counselling and support culturally appropriate exercise interventions in renal care.
Background:Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is an uncommon but potentially serious complication following total shoulder arthroplasty. This study evaluated patient factors associated with post-operative (PO) VTE after anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA). Methods:A retrospective cohort study was performed using the PearlDiver database. Patients undergoing primary aTSA or rTSA with at least 120 days of follow-up were identified using International Classification of Diseases, 10th edition procedure codes. VTE within 90 days post-operatively was the primary outcome. Logistic regression evaluated demographic characteristics, comorbidities, length of stay, Charlson Comorbidity Index, and prior VTE history as predictors of PO VTE. Results:A total of 42,014 patients underwent aTSA and 93,358 underwent rTSA. PO VTE occurred in 256 (0.61%) patients after aTSA and 767 (0.82%) after rTSA. Increased length of stay, higher Charlson Comorbidity Index, obesity, congestive heart failure, prior valve replacement, renal disease, hepatobiliary disease, and pulmonary disease were associated with increased odds of VTE following both procedures. Diabetes, coronary artery disease, hypertension, malignancy, and rheumatoid arthritis were additional risk factors following rTSA. Among 4,576 patients with a prior VTE, 464 (10.14%) experienced recurrent PO VTE, corresponding to a 25-fold increase in odds compared with patients without prior VTE (odds ratio, 25.68; P < .001). Conclusion:PO VTE occurred in fewer than 1% of patients after primary shoulder arthroplasty. Several comorbidities were associated with increased VTE risk, while prior VTE was the strongest predictor of recurrence. These findings may assist in identifying patients who warrant heightened perioperative VTE risk assessment.
Background:The management of the distal humerus in total elbow arthroplasty for rheumatoid arthritis (RA) remains controversial. This study aims to evaluate the clinical, functional, and radiographic outcomes of primary distal resection compared to a non-resection technique. Methods:A comparative study was conducted on 45 patients (45 elbows) with RA. Patients were divided into 2 groups: group 0 (non-resection, n = 22) and group 1 (primary distal humeral resection, n = 23). Range of motion, pain (visual analog scale), Mayo Elbow Performance Score, and Quick Disabilities of the Arm, Shoulder and Hand were assessed with a mean follow-up of 54 months. Reoperation rates and indications were recorded. Results:Both groups showed significant post-operative improvement. However, group 1 achieved superior outcomes in flexion (118.7° vs. 115.7°; P = .015) and lower pain scores. The reoperation rate was significantly higher in group 0 (59.1%) compared to group 1 (13.0%) (P = .002). In the non-resection group, the primary indications for reintervention were combined pain and range of motion limitation (46.2%) and isolated pain (38.5%). Conclusion:Primary distal humeral resection in total elbow arthroplasty for RA is associated with superior functional outcomes and a significant reduction in the risk of secondary surgical procedures.
Background:Although three-dimensional (3D) simulation has improved accuracy of implant placement, its role in optimizing postoperative range of motion (ROM) remains incompletely defined. The purpose of this study was to use a 3D simulation model incorporating scapulothoracic motion to evaluate how implant variables for reverse total shoulder arthroplasty (rTSA) impact standard ROM and functional activities of daily living. Methods:Patients undergoing rTSA from August 2025 to October 2025 were included. Demographics were recorded. Implant parameters recorded included glenosphere size, eccentricity, glenosphere lateralization, polyethylene insert thickness, humeral neck-shaft angle (NSA), humeral stem version, and baseplate version. Outcomes were total ROM, with secondary analyses assessing the effect of individual implant variables on ROM. A 3D simulation model (CORIOGRAPH MODELER, Smith+Nephew) with scapulothoracic and glenohumeral-simulated motion evaluated impingement-free ROM across all implant parameters and 12 motions. Results:Forty-nine patients were included at a median 70.1 years old. Most common surgical indications were glenohumeral osteoarthritis (34.6%) followed by rotator cuff arthropathy (26.5%). Across simulated configurations, larger glenospheres, eccentric glenosphere positioning, and increased glenosphere lateralization were associated with greater impingement-free ROM (P < .05). Higher NSA was associated with lower ROM (P < .05). Multivariable regression found NSA and glenosphere size to be the strongest independent contributors to maximal ROM across multiple motions. Conclusion:Using a 3D simulation model incorporating scapulothoracic motion, rTSA implant positioning was shown to influence impingement-free ROM. Larger and eccentric glenospheres with increased lateralization consistently improved ROM, while higher NSAs limited motion across multiple planes. NSA and glenosphere size were the strongest independent predictors of maximal ROM.
Background:Fatty change progression is an important factor influencing treatment decisions for shoulder disorders. Appropriate evaluation and management of fatty change in the rotator cuff muscles and of its relationship to reverse total shoulder arthroplasty (rTSA) warrant careful consideration. This study aimed to examine the association between post-operative fatty change progression in individual rotator cuff muscles and humeral component design after rTSA. Methods:This retrospective study included 203 patients with large to massive rotator cuff tears or cuff tear arthropathy who underwent rTSA. Of these, 41 patients without glenoid-sided lateralization and with at least 2 years of follow-up imaging were included in the analysis. Patients were treated with either inlay or onlay humeral components. Fatty change progression was assessed using the Goutallier classification for each rotator cuff muscle and was categorized as mild or severe. Post-operative outcomes included active range of motion and patient-reported outcome measures, including the American Shoulder and Elbow Surgeons score and the Constant Murley score. Associations between implant design, fatty change in each rotator cuff muscle, and clinical outcomes were analyzed. The Minimal Clinically Important Difference (MCID) was explored for variables independently associated with outcomes in the primary multivariable models. Results:Sixteen patients underwent inlay and 25 underwent onlay humeral component implantation. Fatty change progression rates were similar between groups for the supraspinatus and teres minor but were lower with the onlay design for the infraspinatus (ISP) and subscapularis (SSC). The onlay design was independently associated with lower post-operative Goutallier grades of the ISP (odds ratio, 0.07; 95% confidence interval, 0.02-0.33) and SSC (odds ratio, 0.11; 95% confidence interval, 0.03-0.44). Post-operative fatty change correlated with pre-operative ones. Fatty change in individual muscles was not associated with post-operative range of motion. Greater post-operative SSC fatty change was independently associated with lower patient-reported outcome measure scores. All patients with mild SSC fatty change or those treated with an onlay component achieved the MCID. In contrast, MCID achievement rates in patients with severe SSC fatty change treated with an inlay component were 56% for the American Shoulder and Elbow Surgeons score and 44% for the Constant Murley score. Conclusion:Greater fatty change progression in the ISP and SSC was associated with the use of an inlay humeral component. An association between post-operative fatty change progression and clinical outcomes was observed in the SSC but not in the other rotator cuff muscles.
Background:Testosterone replacement therapy (TRT) has become increasingly prevalent among men and influences bone metabolism, muscle strength, inflammatory signaling, and pain perception. These factors may affect implant durability and long-term outcomes after primary total shoulder arthroplasty (TSA). While perioperative risks of hormonal therapies have been evaluated in other orthopedic populations, the relationship between pre-operative TRT exposure and long-term TSA outcomes remains poorly understood. The purpose of this study was to evaluate the association between pre-operative injectable TRT use and long-term post-operative outcomes following primary TSA. Methods:A retrospective cohort study was conducted using the TriNetX US Collaborative Network to identify male patients aged ≥18 years who underwent primary TSA between 2005 and 2020, identified by Current Procedural Terminology code 23472. Patients with documented injectable TRT use within one year before surgery were compared with nonusers, and patients with a history of prostate or male breast cancer were excluded. Current Procedural Terminology 23472 captures primary TSA and includes both anatomic and reverse procedures; revision shoulder arthroplasties were not included. One-to-one propensity score matching was performed based on demographics and comorbidities. Five-year post-operative outcomes were assessed using risk ratios (RRs) with 95% confidence intervals (CIs). The Benjamini-Hochberg procedure was applied to control the false discovery rate across outcomes, with significance set at an adjusted P < .05. Results:Before matching, 36,084 patients met the inclusion criteria; 903 were assigned to the pre-operative injectable TRT cohort and 35,181 to the no-TRT cohort. After 1:1 propensity score matching, 901 patients remained in each cohort. At 5 years, after correction for multiple comparisons, TRT use was associated with higher rates of revision surgery (3.46% vs. 1.23%; RR: 2.82; 95% CI: 1.43-5.57; adjusted P = .006), mechanical complications (8.01% vs. 4.83%; RR: 1.66; 95% CI: 1.14-2.42; adjusted P = .018), and shoulder pain (67.4% vs. 60.0%; RR: 1.12; 95% CI: 1.05-1.20; adjusted P = .006). Opioid use disorder was more frequent among TRT users (2.99% vs. 1.50%; RR: 1.99; 95% CI: 1.02-3.86) but did not remain significant after correction (adjusted P = .067). Conclusion:Pre-operative injectable TRT use in men undergoing primary TSA was associated with higher 5-year risks of revision surgery, mechanical complications, and shoulder pain. These associations do not establish causation and should be regarded as hypothesis-generating; they support the need for long-term outcome surveillance and perioperative counseling for TSA patients receiving TRT.
Background:Reverse total shoulder arthroplasty (rTSA) is the mainstay of treatment after failed anatomic TSA. The purpose of this study was to demonstrate patient-reported outcomes and re-revision rates after rTSA performed for failed anatomic total shoulder arthroplasty. Methods:Between 2002 and 2022, 267 shoulders underwent revision rTSA after failed TSA in this single surgeon institutional database. From this cohort, 188 shoulders (70.41%) had minimum 1-year clinical follow-up and were included in outcomes analysis. Outcomes including American Shoulder and Elbow Surgeons score, Simple Shoulder Test, stability score, visual analog scale pain, visual analog scale function, and patient satisfaction were collected both pre-operatively and post-operatively. Range of motion (ROM) measurements were recorded including forward flexion, abduction, external rotation, and internal rotation. Demographics and surgical factors including implant characteristics, use of bone graft, and indication for revision rTSA were included. Re-revisions were identified, and risk factors were analyzed. Statistical analysis including student's t-test, chi-square analysis, logistic regression, and multivariate stepwise regression was performed. Results:The average age at revision rTSA was 67.97 years, and average follow-up period was 61.72 months. Glenoid component loosening (40.82%) and rotator cuff failure (37.45%) were the most common indications for revision rTSA. There were improvements in American Shoulder and Elbow Surgeons scores at 1-year follow-up (pre-operative 30.41 ± 16.64, post-operative 66.04 ± 24.93, P < .001). All ROM parameters improved from the pre-operative period to 1-year follow-up, with forward elevation improving from 70° to 129° (P < .001). Abduction improved from 64° to 119° (P < .001). External rotation improved from 27° to 38° (P = .009). Internal rotation, which was graded on a 0-8 scale, improved from 3.06 to 3.92 (P = .005). A total of 28 patients (10.49%) underwent re-revision at a mean time of 33.3 months. Baseplate failure was the most common re-revision indication (n = 14, 5.2%). Use of a larger, load sharing glenosphere was associated with a lower risk of baseplate failure requiring re-revision (2.4% vs. 6.2%, P < .001). Conclusions:Revision rTSA after failed TSA demonstrates significant improvements in patient-reported outcomes and ROM at an average follow-up period of greater than 5 years. Baseplate failure is the most common reason for re-revision. In this implant family, larger glenospheres were associated with lower baseplate-related re-revision in exploratory analysis. Use of larger glenosphere sizes (40-44 mm) is associated with lower rates of baseplate failure in this population within an implant system where the glenosphere is designed to contact the underlying glenoid bone. This finding should not be generalized to implant systems that do not share this design characteristic.
Background:Cognitive impairment or dementia has been linked to adverse outcomes in orthopedic surgery. However, studies evaluating its impact on perioperative outcomes after total shoulder arthroplasty (TSA) have been limited. The aim of this study is to examine the association between pre-operative dementia and short-term outcomes following TSA. Methods:Patients undergoing elective primary TSA over 2021-2023 were retrospectively identified and analyzed in the National Surgical Quality Improvement Program database. Patients with and without dementia were matched based on patient demographics and comorbidities. Thirty-day post-operative outcomes such as length of stay and complications were analyzed via univariate analyses. Results:A total of 6,120 patients who underwent elective primary TSA were identified. After 5:1 propensity matching, 219 patients with pre-operative dementia and 1,095 patients without pre-operative dementia were included. The dementia cohort, on average, experienced a longer length of stay (2.2 ± 3.0 days vs. 1.7 ± 4.3 days, P = .047), more frequent discharge to a nonhome setting (26.5% vs. 13.3%, P < .001), and a higher rate of readmission within 30 days (8.7% vs. 4.7%, P = .029). In addition, this cohort had higher rates of overall complications (10.0% vs. 6.0%, P = .043) and minor complications (7.8% vs. 3.9%, P = .021), as well as the rate of bleeding resulting in transfusion (5.5% vs. 2.0%, P = .007). Conclusions:Pre-operative dementia is associated with significant increases in adverse short-term outcomes in TSA patients. Dementia may limit patients' ability to follow post-operative instructions, participate in rehabilitation, and manage comorbidities, contributing to worse outcomes. These findings underscore the need for healthcare teams to optimize perioperative and post-operative care in patients with dementia.
Background:The Forgotten Joint Score, a patient-reported outcome measure assessing the ability to forget the artificial joint, has demonstrated minimal ceiling effects in hip and knee arthroplasty patients. This study determines the reliability of an upper extremity 12-item Forgotten Joint Score (FJS-12) in shoulder arthroplasty patients. Methods:The FJS-12 was developed from the previously published 70-item list assessing the Forgotten Joint Score concept in shoulder patients. Sixty patients with glenohumeral osteoarthritis completed the FJS-12 at 6 months (n = 38) or 1 year (n = 22) after anatomic or reverse total shoulder arthroplasty and again at least 48 hours later. Test-retest reliability analysis was conducted using intraclass correlation coefficient (ICC2,1) with 95% confidence intervals (CIs), standard error of measure (SEM90), and minimal detectable change (MDC90). Results:FJS-12 test-retest time frame was 8 ± 5 days (range 2-19 days). Six-month FJS-12 was 64 ± 33 with ICC2,1 = 0.97, 95% CI [0.94-0.98], SEM90 = 9.6, and MDC90 = 13.5. One-year FJS-12 was 70 ± 29 with ICC2,1 = 0.96, 95% CI [0.91-0.98], SEM90 = 10.0, and MDC90 = 14.2. Conclusion:The FJS-12 demonstrated excellent test-retest reliability, representing an important step toward a more sensitive measure to evaluate shoulder arthroplasty outcomes.
Background:Radiocapitellar arthroplasty is a treatment option for pathology of the radial side of the elbow that cannot be managed arthroscopically and for which total elbow arthroplasty is not indicated. The available literature on radiocapitellar arthroplasty is limited. The aim of this study was to evaluate the survival, indications, and surgical approaches based on data from the Dutch Arthroplasty Register. Methods:The Dutch Arthroplasty Register contained 33 radiocapitellar arthroplasties performed between 2014 and 2024, with a median follow-up of 6.5 years (range, 1-10 years). Results:Nine arthroplasties required revision (27%), most commonly due to radial component loosening within 3 years after surgery. Post-traumatic osteoarthritis was the most common indication for radiocapitellar arthroplasty. Half of the patients (17/33) had previous surgery. A lateral approach with detachment of the lateral ulnar collateral ligament was most commonly used. The reported, estimated 10-year overall survival rate was 60%. Conclusion:Despite the relatively high revision rate, radiocapitellar arthroplasty may still have a role within clinical trials with strict inclusion criteria and structured follow-up. Limited implant availability currently represents a barrier to clinical use. In all cases, the revision rate should be discussed with the patients before surgery.
Background:Extended reality (XR) has seen increased usage in shoulder arthroplasty for both intraoperative guidance and surgical training, but its impact on technical accuracy and performance has not been quantified across studies. The objective of this analysis was to determine the impact of XR on educational efficiency and glenoid guidewire placement error. Two separate meta-analyses of randomized or quasi-experimental studies were performed. Methods:Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses search guidelines, 24 studies were identified in XR-based shoulder surgery education. After applying inclusion, 3 studies involving 55 participants were meta-analyzed. Using the same Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 35 studies were identified in XR-guided shoulder arthroplasty. After applying inclusion criteria, 7 studies involving 349 guidewire placements were meta-analyzed. Results:In the surgical education studies, XR-trained participants completed procedures faster than controls, but OSAT (Objective Structured Assessment of Technical Skills) scores did not significantly differ. Across the glenoid guidewire studies, XR guidance reduced version error and inclination error versus freehand, but entry point error was not significantly different between XR-guided procedures and freehand. Conclusion:XR-based tools appear to offer meaningful benefits for shoulder arthroplasty, but their impact may be domain-specific. XR education may substantially improve operative efficiency, while XR guidance may enhance the angular accuracy of glenoid guidewire placement without clearly changing entry point error.
