Background Shoulder arthroplasty is increasingly utilized to treat shoulder arthritis, cuff tear arthropathy and proximal humerus fractures. Onlay allograft cortical strut augmentation is a common technique used in the management of humeral bone loss, periprosthetic fractures, and during revision surgeries to enhance stability and potentially reconstitute bone. This study investigated the biomechanical performance of three commonly used strut fixation methods used to secure an allograft strut to host diaphyseal bone: suture-tape cerclage, wire cerclage and lag screw fixation. Methods Eight unique onlay cortical tibial allograft struts were affixed to cadaveric humeral diaphyseal specimens using suture-tape cerclage, wire cerclage and lag screw fixation. Static testing measured the mean compressive force and contact area between the strut and the humeral shaft. Dynamic testing involved cyclical shear loading applied to the strut up to 150 N. Statically tested fixation configurations were three and five-point fixation constructs for suture-tape and wire cerclage, and three bi-cortically and tri-cortically engaging lag screws. Dynamically tested fixation configurations were five-point constructs for suture-tape and wire cerclage, and three bi-cortically engaging lag screws. Results In static testing, 3-lag screw bi-cortical and tri-cortical fixation and three and 5-wire cerclage fixation demonstrated a significantly greater mean compressive force and contact area compared to both three and 5-suture-tape cerclage configurations (P < 0.004) and (P ≤ 0.003). Five-wire cerclage technique exhibited a greater mean compressive force (P= 0.003) and contact area (P= 0.008) than the 3-wire fixation technique. Additionally, 3-lag screw tri-cortical fixation produced a significantly greater mean compressive force (P = 0.040) and contact area (P = 0.026) compared to the 3-wire cerclage fixation technique. In dynamic testing, the 5-suture-tape cerclage technique exhibited a significantly lower mean compressive force and contact area compared to both the 3-lag screw bi-cortical (P < 0.001) and (P < 0.001) and 5-wire cerclage (P < 0.001) and (P ≤ 0.002) fixation techniques. Five suture-tape cerclage fixation exhibited significantly greater strut translation beyond 50 N of cyclical loading (P <0.033). Conclusion Bi- and tri-cortical lag screw and wire cerclage fixation techniques are biomechanically superior to suture-tape cerclage for the fixation of tibial allograft struts to humeral shafts. Wire cerclage requires greater fixation density than lag screw fixation in order to generate a comparable contact force and area. Additionally, lag screw fixation lessens the need for circumferential exposure for safe wire and suture passage, potentially mitigating the risk of a radial nerve injury. Level of Evidence Basic Science Study, Biomechanics
BACKGROUND:The optimal regional anesthesia strategy for anatomic and reverse total shoulder arthroplasty (aTSA/rTSA) remains a subject of debate. While single-shot interscalene blocks (SSIB) are often limited by short duration and potential rebound pain, continuous interscalene catheters (CIC) are associated with higher complication rates and procedural complexity. This meta-analysis evaluates the effectiveness and safety of both techniques, specifically investigating the impact of the local anesthetic agent. METHODS:A systematic search was conducted in PubMed, Embase, CENTRAL, and CINAHL through March 2026 for RCTs and observational studies. The primary outcome was pain intensity (VAS/NRS) at 24 hours. Secondary outcomes included opioid consumption, length of hospital stay (LOS), technical and block-related complications, and procedural costs. RESULTS:Seven studies involving 2,639 patients were included (1,182 SSIB, 1,457 CIC). No statistically significant global difference was found regarding 24-hour pain scores (MD -0.23; P = .70) or opioid consumption (P = .91). In subgroup analysis, CIC was associated with lower pain scores when standard local anesthetics were used (MD 1.18; P < .001), whereas SSIB with liposomal bupivacaine was associated with borderline lower pain scores (MD -1.02; P = .05); however, these differences lie at the lower margin of published thresholds for a minimal clinically important difference (MCID) in acute postoperative pain. A post hoc analysis at 48 hours (three studies, 695 patients) showed no significant difference (MD -0.81; P = .20). SSIB was associated with a more than fourfold lower rate of technical and block-related complications (0.4% vs. 4.6%; RR 0.22; P = .005). No significant difference was observed in LOS (P = .45); material costs, compared descriptively, were higher for CIC ($357-$474) than for SSIB ($24-$190). CONCLUSION:At 24 hours, SSIB was associated with analgesia comparable to CIC, with the direction of effect depending on the local anesthetic agent used. SSIB was associated with significantly fewer technical and block-related complications and lower material costs. These findings suggest a favorable risk-benefit profile of SSIB for primary shoulder arthroplasty, although outcomes beyond 48 hours require further investigation. LEVEL OF EVIDENCE:Level III, Systematic Review/Meta-Analysis, Treatment Study.
BACKGROUND:Shoulder arthroplasty is among the fastest-growing procedures in orthopaedic surgery. The purpose of this study was to characterize national trends in the geographic distribution of surgeons performing shoulder arthroplasty across rural-urban commuting area (RUCA) settlement types and to evaluate how surgeon distribution relates to procedural volume and procedures per surgeon. We hypothesized that the urban proportion of surgeons would decline over time. METHODS:The Medicare Provider Utilization and Payment Data: Physician and Other Practitioners dataset was queried to identify orthopaedic surgeons performing shoulder arthroplasty from 2013 to 2024 using Healthcare Common Procedure Coding System codes (23470, 23472, 23473, 23474). Surgeons were counted as unique National Provider Identifiers and non-physician providers were excluded. RUCA classifications supplied within the dataset were categorized as urban/metropolitan, large town, small town, or rural. Temporal trends in surgeon distribution were assessed using Kendall's tau rank correlation. Trends in procedures per surgeon were evaluated using Mann-Kendall testing with Sen's slope estimation. P values were corrected for multiple comparisons using the Benjamini-Hochberg procedure, with significance defined as q < 0.05. RESULTS:A total of 533,569 shoulder arthroplasty procedures were performed during the study period, increasing from 23,758 in 2013 to 76,013 in 2024, a 3.2-fold increase, while the number of surgeons increased from 974 to 2,649. Surgeons were predominantly located in urban regions (88.9%), followed by large town (9.4%), small town (1.4%), and rural areas (0.3%). Procedural growth was driven primarily by urban and large town regions, while rural volume did not increase significantly (CC = 0.412, q = 0.071). The urban proportion of surgeons declined from 91.0% to 89.0% (CC = -0.758, q < 0.001) while small town and large town proportions increased; the rural proportion did not change (CC = -0.030, q = 0.947). Median procedures per surgeon were highest in rural areas throughout, with no significant decline in any settlement type. Revision shoulder arthroplasty was performed almost exclusively in urban centers, with no cases in rural or small town regions. CONCLUSION:Despite substantial growth in shoulder arthroplasty utilization, surgeons remain highly concentrated in urban regions. Growth extended into large and small towns while the rural proportion of the workforce did not change. Revision shoulder arthroplasty was performed almost exclusively by urban surgeons, although the reporting threshold applied to this dataset limits what can be concluded from revision counts. Growth in shoulder arthroplasty has therefore reached less urbanized communities but not rural ones. LEVEL OF EVIDENCE:Level IV, Descriptive Epidemiology Study.
Background The diagnosis of periprosthetic joint infection (PJI) following shoulder arthroplasty remains challenging. Serum lab markers and joint aspirations demonstrate limited sensitivity and specificity in this setting. Arthroscopic pre-revision tissue biopsy (PTB) may improve organism-level diagnosis prior to revision surgery. Methods A retrospective review of consecutive patients who underwent an arthroscopic PTB from a single center from 2018-2025 was conducted. PTB was performed prior to revision surgery at the discretion of the attending surgeon to aid in the diagnosis of possible PJI and inform decision-making pertaining to revision surgery. Diagnostic performance, including sensitivity, specificity, and positive predictive value, and negative predictive value of arthroscopic PTB for diagnosing PJI were calculated using intraoperative cultures at the time of ultimate revision as the gold standard based on the 2018 International Consensus Meeting on Musculoskeletal Infection (ICM) PJI Criteria. Results Twenty-three patients met the inclusion criteria, with eleven (47.8%) meeting criteria for PJI according to the 2018 ICM criteria. When using either ≥2 concordant positive cultures at the time of revision or ICM criteria as the reference standard, PTB demonstrated poor sensitivity (30.0% [95% CI, 6.7-65.3%] and 27.3% [95% CI 6-61%], respectively) and low negative predictive value (65.0% [95% CI, 55.3-73.6%] and 60%, [95% CI 51.1-68.3%] respectively). In total, three patients who had all negative cultures at the time of PTB eventually demonstrated ≥2 unexpected positive cultures at revision. Clinically, these findings suggest that a negative PTB result should not be used in isolation to support implant retention or to defer revision surgery when clinical suspicion for infection persists. Conclusion Pre-revision tissue biopsy demonstrated poor sensitivity and NPV in the detection of PJI. Negative PTB findings did not exclude infection, and results should be taken into context with other clinical and laboratory data. Future research should focus on determining if there are patient-specific factors or clinical scenarios in which PTB may be beneficial. Level of Evidence III, Retrospective Case Control Design, Diagnostic Study
Facioscapulohumeral muscular dystrophy (FSHD) is the third most common hereditary myopathy and a major cause of progressive shoulder girdle dysfunction. Despite its clinical relevance, FSHD diagnosis is often delayed or mistaken for peripheral nerve disorders. For the shoulder surgeons, FSHD presents a challenge in which progressive degeneration of the periscapular musculature results in scapular winging and impaired overhead activity. Physical examination is relevant for surgical decision-making, including assessment of scapular winging, deltoid integrity, and response to manual scapular stabilization. Nonoperative treatment may provide symptomatic support, but evidence remains limited. Scapulothoracic arthrodesis is the principal surgical option for appropriately selected patients, particularly those with severe scapular winging, active elevation below 90°, and preserved deltoid function. This review provides a clinically focused overview of FSHD for shoulder surgeons, emphasizing clinical presentation, diagnostic evaluation, and surgical patient selection, operative technique, rehabilitation, expected outcomes and complications.
Background Medial (ME) and lateral epicondylitis (LE) are common elbow pathologies characterized by flexor-pronator and extensor carpi radialis brevis tendinous degeneration, respectively. While nonoperative treatment is often successful, some patients do require surgical intervention. Little data exists on the long-term postoperative recovery outcomes of patients in terms of reoperation rate, return of symptoms, and return to activity. Even further, little information exists describing risk factors associated with failing nonoperative interventions. The purpose of the study was threefold: 1) present the senior author’s surgical technique used in the treatment for medial and lateral epicondylitis in those cases refractory to nonoperative management, 2) report the long-term outcomes of patients undergoing operative intervention with this surgical technique, and 3) describe the factors associated with failure of nonoperative management that led to surgical intervention. Methods Data on demographics, sport participation, medical comorbidities, and attempted preoperative treatment, were collected for patients who underwent surgical intervention for ME and LE. Patients were contacted to obtain data on outcomes including persistent symptoms and ability to return to work. Logistic regression analysis was performed to identify risk factors associated with failure of nonoperative management. Results Of 548 patients treated for medial and lateral epicondylitis over the study period, 200 (34.6%) failed conservative measures after mean 14 months of nonoperative treatment. Of the 200 surgical patients, 119/200 (59.5%) were males with mean age of 51.6 years (range 30-72 years). Eighty (80%) percent (160/200) of operative cases were for LE. Patient reported outcomes were obtained from 165/200 patients (82% response rate), with mean 9.1 years of follow up (range 1.1-19.3 years). At time of final follow up, average patient reported percentage of resolution of preoperative symptoms was 94.5%, average current daily elbow pain was 0.4 out of 10. Ninety-six (96%) percent reported ability to return to work fully; 4.2% of patients reported persistent difficulties with activities of daily living. After multivariate logistic regression analysis, diagnoses of hyperlipidemia and anxiety/depression as well as history of smoking were the most significant risk factors for failing nonoperative management. Conclusion In this single-surgeon case series, a cost-effective, open, efficient transosseous tunnel repair yielded durable, excellent long-term outcomes, including marked symptom relief, minimal residual pain, and high return to activity rates at a mean 9-year follow-up. When examining risks for failing nonoperative management, hyperlipidemia and greater cumulative risk factor burden were predictive of progression to operative intervention.
Background With the rising utilization of large language models (LLMs), such as OpenEvidence (OE), ChatGPT-4o (GPT), Google Gemini (GG), and DeepSeek (DS), their use in complex Orthopaedic cases remains unclear. Massive irreparable rotator cuff tears (MIRCTs) represent a challenging clinical scenario requiring nuanced, patient-specific decision-making. We evaluated the concordance of LLM-generated surgical recommendations with expert consensus derived from a Delphi study by the American Shoulder and Elbow Surgeons (ASES) Neer Circle and compared the various LLM models against each other. Methods Sixty-one MIRCT Delphi consensus scenarios were entered into the most current free version of each LLM in a standardized prompt format in June 2025. Recommendations were categorized as fully concordant or discordant with Delphi consensus. Further LLM testing included the addition of diabetes, smoking, and their combination. Accuracy (%) for each LLM and test with differences assessed using Cochran’s Q test and McNemar’s tests. A generalized linear mixed model identified significant predictors of AI-LLM accuracy, while the relationship between Delphi consensus strength and LLM concordance was assessed using Spearman's rank correlation coefficient. Results A total of 976 recommendations (61 scenarios × 4 platforms x 4 tests) were analyzed. OE demonstrated the greatest accuracy across all 4 tests (65.6%, 68.9%, 62.3%, and 65.6%, respectively) (p < 0.05), while DS consistently scoring the lowest. Accuracy was significantly positively predicted by age greater than 70 (OR 31.6, p < 0.001), dynamic instability (OR 18.8, p = 0.002), and pseudoparesis (OR 2.9, p = 0.025), and negatively predicted by intact or anatomically reparable subscapularis (OR 0.17, p = 0.001). There was a significant positive correlation between the strength of Delphi expert consensus and the number of LLM platforms concordant with that consensus (Spearman's ρ = 0.493, p < 0.001). Discussion & Conclusion This study is the first to systematically compare multiple LLMs against recommendations of an MIRCT Delphi consensus study. OE and GPT demonstrated the highest concordance; however, they did not approach levels of expert decision-making in many scenarios. LLMs have potential as adjunctive decision-support tools, particularly in resource-limited settings or for generalists managing complex shoulder pathology. Level of Evidence Basic Science Study, Computer Modeling using AI;
BACKGROUND:Heterotopic ossification (HO) is a major complication following complex elbow fracture-dislocations and often leads to postoperative stiffness and impaired functional recovery. However, data focusing exclusively on complex elbow fracture-dislocations remain limited. The aim of this study was to determine the incidence and severity of HO, identify independent risk factors, and evaluate its impact on mid-term functional outcome. METHODS:A retrospective cohort study was performed including 169 patients who underwent surgical treatment for complex elbow fracture-dislocations between 2010 and 2020 at a level I trauma centre. Injury patterns comprised terrible triad injuries, Monteggia(-like) fractures, anteromedial coronoid fractures, and transolecranon fracture-dislocations. HO was classified according to Hastings and Graham. Functional outcome was assessed using range of motion (ROM), Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder and Hand (DASH) score at a mean follow-up of 4.6 years (2.0 to 10.3). Multivariable logistic regression analysis was performed to identify independent predictors of HO. RESULTS:HO developed in 55 patients (32.5%), with 28 cases (50.8%) classified as higher-grade (≥ grade II). Surgical excision of symptomatic HO was required in 12 patients. HO was associated with significantly reduced ROM (Flexion/Extension 107° ±25 vs. 119° ±26, p=0.005; Pronation/Supination 153 ±31 vs. 163 ±27, p=0.040), and inferior MEPS, OES, and DASH scores (all p<0.05). Male sex (OR 2.8; 95% CI 1.44-5.55; p=0.003), terrible triad injuries (OR 3.04; 95% CI 1.55-5.98; p=0.002), and delayed surgery (>5 days) (OR 2.2; p=0.040) were independently associated with HO formation. The strongest association was observed for terrible triad injuries, whereas delayed surgery showed a more moderate association. Age, BMI, ASA classification, smoking, operative duration, and non-steroidal anti-inflammatory drug (NSAID) prophylaxis were not significantly associated. CONCLUSION:HO occurs in approximately one third of patients after surgical treatment of complex elbow fracture-dislocations and is associated with inferior elbow mobility and elbow performance scores. Male sex and terrible triad injuries showed the strongest associations with HO formation, whereas delayed definitive surgery was associated with a more moderate increase in the odds of HO. Early stabilization and close postoperative surveillance are particularly important in high-risk patients. LEVEL OF EVIDENCE:Level III, retrospective cohort comparison, prognosis study.
Background To investigate the effects of motor control (MC) exercises delivered via telerehabilitation on shoulder function and quality of life in patients undergoing arthroscopic rotator cuff (RC) surgery. Methods Patients who underwent arthroscopic RC surgery were included in the study. Participants were evaluated pain (Visual Analog Scale, VAS), active range of motion (AROM), lateral scapular slide test (LSST), shoulder girdle and handgrip muscle strength, function (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, ASES), kinesiophobia (Tampa Scale for Kinesiophobia, TSK), and quality of life (Western Ontario Rotator Cuff Index, WORC). Participants were randomly allocated into two groups: the Standard Rehabilitation (STD) group and the Motor Control (MC) group. Both groups received telerehabilitation sessions twice weekly for 12 weeks. Between-group comparisons and within-group time-dependent analyses were performed. Results A total of 34 participants (29 females, 5 males; STD=17, MC=17) were included. Postoperatively, both groups demonstrated significant improvements over time in pain, AROM, muscle strength, and functional scores (p<0.05). In the MC group, night pain was significantly lower at week 6, and shoulder external rotation (ER) AROM was significantly higher at week 12 (p<0.05). Differences, changes, and rates of scapular dyskinesis in all three positions (0°, 45°, and 90° abduction) of the LSST were significantly better in the MC group (p<0.001), with a significant group×time interaction (p<0.05). Muscle strength and strength gains in shoulder flexion, abduction, and scapular elevation were significantly greater in the MC group (p<0.05). No significant between-group differences were observed in ASES, TSK, or WORC scores or their changes (p>0.05). Conclusion According to our findings, the addition of motor control exercises delivered via telerehabilitation to standard rehabilitation is more effective than standard rehabilitation alone in improving scapular mobility and increasing muscle strength in shoulder flexion, abduction, and scapular plane elevation.
BACKGROUND:Limited evidence compares reoperation, patient-reported outcomes (PROs), and mortality between inferiorized and lateralized glenospheres in reverse total shoulder arthroplasty (rTSA). METHODS:Single-institution retrospective review was performed of all primary rTSAs performed by a single surgeon using the LimaCorporate SMR Reverse Shoulder System between 2014 and 2025. Demographics, surgical data, reoperation, mortality, and PROs were obtained; American Shoulder and Elbow Surgeons (ASES) and visual analog scale (VAS) pain scores were collected preoperatively and postoperatively between 6 and 12 months. Cumulative incidence of reoperation (CIR) was estimated using competing-risks methodology with death as a competing event; group differences were assessed using Fine-Gray regression. Inverse probability weighting (IPW) was used to adjust for confounding in multivariable regression analyses assessing the association between glenosphere type and each endpoint. RESULTS:Overall, 329 inferiorized and 131 lateralized glenospheres were included with respective mean ages of 72.9 and 71.6 years (p=0.60), minimum follow up of 12 months, median follow-up of 31.3 and 12.2 months (p<0.001), and PRO completion percentages of 59% and 64% (p=0.77). There were no significant differences between inferiorized and lateralized glenospheres with respect to 36-month CIR (4.9% versus 4.4%; p=0.37), with similar findings at 12 and 24 months, improvements in ASES (46.2 vs. 50.2; p=0.26) or VAS pain (-4.2 vs. -4.2; p=0.97), minimal clinically important difference achievement for ASES (87.1% vs. 84.5%; p=0.57) or VAS pain (82.5% vs. 78.6%; p=0.50), and mortality (4% vs. 1.5%; p=0.25). Glenosphere type was not significantly associated with CIR, reoperation, PROs, or mortality. CONCLUSION:Within the limitations of this retrospective study, inferiorized and lateralized glenospheres using the LimaCorporate SMR Reverse Shoulder System demonstrated comparable short-term clinical outcomes despite differing follow-up durations between cohorts. Longer-term follow-up is needed to determine whether clinically meaningful differences emerge over time. LEVEL OF EVIDENCE:Level III, Retrospective Cohort Comparison, Treatment Study.
BACKGROUND:Hand behind the back (HBB) after reverse shoulder arthroplasty (rTSA) is important for activities of daily living (ADLs), but the commonly used vertebral-level measurements are inconsistent and only moderately reliable. Collin et al. described three functional HBB motion patterns that capture how patients reach posteriorly (fluently vs, assisted) rather than how high they reach. We adapted this model into a bedside tool, the "HBB Classification", and compared its interobserver reliability with the traditional vertebral-level method. METHODS:In this prospective, single-centre, observational cohort study, 116 shoulders that had undergone rTSA were assessed during routine postoperative follow-up visits. HBB function was evaluated by two blinded observers (a fellowship-trained shoulder surgeon and a physiotherapist) using two classification systems during the same clinical session: (1) the traditional vertebral-level method and (2) the HBB classification (Type 1: unable to achieve HBB; Type 2: HBB achieved but not fluent or assisted; Type 3: fluent, unassisted). Demographic data and surgical approach were recorded. Interobserver reliability was assessed using percent agreement and Cohen's kappa coefficient, and kappa values were compared using Fleiss' Z test, with statistical significance set at p < 0.05. Postoperative functional outcomes (Constant score, SST, ADLER, and SSV) were also compared across HBB categories. RESULTS:Mean age at surgery was 70.7 ± 7.5 years (range, 52-91 years). The cohort included 116 shoulders from 110 patients; 65 patients (59.1%) were women, and 86 shoulders (74.1%) were right-sided. Mean follow-up was 15.8 ± 14.7 months (range, 6-83 months). Indications were cuff-tear arthropathy 36 (31.0%), primary osteoarthritis 31 (26.7%), massive rotator cuff tear 33 (28.4%), sequelae of fracture 7 (6.0%), and other/revision indications 9 (7.9%). Interobserver agreement for the vertebral-level method was 66.4%, with κ = 0.599 (95% CI 0.49-0.69; moderate). Agreement for the HBB classification was 96.6%, with κ = 0.945 (95% CI 0.90-0.98; almost perfect). The difference in κ was Δκ = 0.346, and was statistically significant (Z = 6.09, p < 0.000001). HBB categories were also significantly associated with postoperative functional outcome measures (SST, ADLER, Constant score, and SSV). CONCLUSION:The HBB classification showed almost-perfect interobserver reliability and significantly outperformed the traditional vertebral-level method. As a clinical adaptation of the Southard three-pattern framework, it provides a practical, functionally meaningful, and highly reproducible way to report HBB after rTSA while its significant association with postoperative functional outcome measures further supports its clinical relevance. LEVEL OF EVIDENCE:Basic Science Study, Validation of Classification System.
Background Reverse total shoulder arthroplasty (rTSA) for chronic locked anterior shoulder dislocations (CD) remains challenging due to glenoid bone loss, soft-tissue contractures, and risk of postoperative stiffness and instability. Outcomes of rTSA for CD remain poorly defined, particularly compared with rTSA for proximal humerus fractures (PHF), another high-risk indication associated with inferior results relative to traditional rTSA indications. This study evaluated clinical and radiographic outcomes of rTSA for CD versus PHF. We hypothesized CD patients would demonstrate inferior postoperative outcomes compared with PHF patients. Materials & Methods A retrospective review was performed of all patients who underwent rTSA for CD or PHF between August 2015 and November 2024 at a single academic institution. CD patients were matched 1:3 to PHF controls using propensity scores, controlling for age at surgery, gender, body mass index, American Society of Anesthesiologists score, diabetes status, smoking status, insurance type, and follow-up duration.Collected variables included demographics, mechanism of injury, time to surgery after injury and preoperative radiographic findings. Postoperative outcomes included active forward elevation (AFE), active external rotation (ER), internal rotation (IR) score, complications and reoperations. Patient-Reported Outcomes Measurement Information System (PROMIS) scores, including PROMIS Upper Extremity (P-UE), PROMIS Pain Interference (P-Interference), and PROMIS Pain Intensity (P-Intensity) were also recorded. Results A total of 17 CD patients were included in this study. 11 patients had pure anterior dislocation, six patients had an associated glenoid fracture, and three had additional greater tuberosity fractures. The CD cohort collectively was then matched to 51 PHF controls. The mean follow-up was duration was 28.1 (CD) and 20.9 (PHF) months (p = 0.39).There were no differences in the postoperative AFE, ER, and IR measurements between the CD and PHF cohorts. Heterotopic ossification (capsular ossification) was more common in the CD group (23.5% vs. 3.9; p = .04) but there were no differences in other complications, revision or reoperation rate between the CD and PHF cohort. The CD cohort demonstrated lower P-UE scores compared with PHF patients (36.2 ± 8.6 vs 56.6 ± 9.8, P < .001). CD patients also had higher P-Interference scores (53.9 ± 9.0 vs 46.2 ± 10.1, P = .03). Conclusion rTSA for CD results in lower functional outcome scores and higher pain interference scores, but comparable range of motion compared to rTSA for PHFs. The presence of a glenoid fracture or greater tuberosity fracture did not affect outcomes of rTSA in patients with CD.
Background The effect of increased cross linking of modular polyethylene components in primary total stemmed reverse shoulder replacement (rTSA) upon revision rates is unknown outside biomechanical testing. We compared the rate of revision of primary stemmed reverse shoulder replacement with either a highly crosslinked (XLPE) or non-highly crosslinked polyethylene (non-XLPE) glenosphere or humeral cup. Materials and Methods Using data from the Australian Orthopaedic Association National Joint Replacement Registry, all primary rTSA with either polyethylene humeral cups or glenospheres were identified for the period 1 January 2006 to 31 December 2024. The procedures were restricted to the three most common primary diagnoses: osteoarthritis (OA), rotator cuff arthropathy (RCA) and fracture. Within each diagnostic category, procedures were stratified by XLPE or non-XLPE polyethylene type. For each implant type (humeral cups and glenospheres), this created six comparison groups: OA (XLPE vs non-XLPE), RCA (XLPE vs non-XLPE), and fracture (XLPE vs non-XLPE). The cumulative percent revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazard models adjusted for age and sex. A sub analysis from 2015 allowed further adjustment for ASA, BMI, glenosphere size and image derived instrumentation. Results Of the 28,819 rTSA for OA, 24,779 for RCA and 9,904 for fracture there was an increased risk of revision for non-XLPE compared to XLPE glenospheres for OA from 1.5 years HR=3.21 (95% confidence interval (CI)1.59, 6.47), p=0.001). but not for RCA or fracture. The rate of revision was increased for OA non-XLPE vs XLPE humeral cups, but other diagnoses did not differ (HR=1.30 (95% CI 1.10, 1.54), p=0.002), with the most common reason for revision being infection in the non-XLPE OA cohort. At sub-group analysis, the revision rate of non-XLPE humeral cups was increased compared to XLPE for OA and RCA but not fracture (HR=1.84 (95%CI 1.42, 2.40), p<0.001, and HR=1.47 (95% CI 1.16, 1.86), p=0.001, respectively) by multivariable adjustment. Discussion/Conclusion Changes to the amount of cross-linking to polyethylene bearing surfaces in rTSA are associated with variations in all-cause revision rates depending on the primary diagnosis. Patients with non-XLPE components are associated with a higher revision rate compared with XLPE components when used in stemmed rTSA for OA and RCA (particularly infection requiring revision). While at sub-group analysis the revision risk of rTSA with polyethylene glenosphere constructs is confounded by patient, implant characteristics, and surgeon assistive tools as covariates, the evidence suggests increased revision of rTSA with non-XLPE humeral cups.
