Objective To study the frequency and predictors of 90-day cardiopulmonary complications following primary shoulder arthroplasty. Methods We used prospectively collected data from the Mayo Clinic ...Total Joint registry from 1976 to 2008. We used univariate and multivariable-adjusted Cox regression analyses to examine the association of age, gender, body mass index, comorbidity assessed by Deyo-Charlson index, American Society of Anesthesiologist class, implant fixation (cemented versus not), and underlying diagnosis with the risk of 90-day cardiopulmonary complications after primary shoulder arthroplasty. Odds ratio (OR) with 95% confidence interval (CI) and P values are presented. Results A total of 3480 patients underwent 4019 primary shoulder arthroplasties. Ninety-day cardiac and thromboembolic complication rates following primary shoulder arthroplasty were 2.6% (92/3480) and 1.2% (42/3480). After multivariable-adjustment, age >70 years (OR, 2.7; 95% CI: 1.2-5.9; P value = 0.01; relative to age <60), Deyo-Charlson comorbidity index of 1 or more (OR, 3.27; 95% CI:1.9-5.6; P < 0.0001; relative to index of 0), and prior cardiac events (OR, 7.87; 95% CI: 4.89-12.68; P < 0.0001; relative to no prior event) were associated with higher odds of 90-day cardiac complications. Due to a few thromboembolic events, only univariate analyses were performed. Univariately, female gender, age >70 years, body mass index 25 to 29.9 kg/m2 , Deyo Charlson index of 1 or more, underlying diagnosis of trauma, prior thromboembolic event, and surgery type were each associated with significantly higher risk of 90-day thromboembolic event ( P ≤ 0.03 for all). Conclusions Cardiac and thromboembolic complications are uncommon after primary shoulder arthroplasty. Patients can be informed of their risk of cardiac complications following shoulder arthroplasty based on the presence of risk factors.
Hybrid constructs have been used as a primary fixation technique in primary anatomic total shoulder arthroplasty for more than a decade. A highly porous metal central peg, metal cage, or coatings ...attached to the surface of cemented polyethylene glenoid component have been used with the concept of providing an additional adjunct in promoting osseointegration, preventing glenoid component loosening, and promoting longer-term success. The purpose of this article is to analyze the published results, complications, as well as rate of revision using this form of glenoid fixation. In addition, key aspects of the surgical technique that may be considered to facilitate optimal results when hybrid fixation is considered in total shoulder arthroplasty are also reviewed.
Background Long-stemmed humeral components are often associated with revision shoulder arthroplasty. However, long-stemmed humeral components will likely prove useful in selected patients with extra ...large shoulders and in those with bone loss from nonarthroplasty causes and in humeral fractures. This study was developed to examine the frequency of use of longer humeral stems, identify the indications for their use, define the results, and enumerate the complications encountered. Materials and methods Thirty-five primary shoulder arthroplasties were followed-up clinically and radiographically for at least 2 years or until revision surgery. The primary indications for use of an intermediate or long stem were a large humeral canal in 18 shoulders and severe preoperative metaphyseal or diaphyseal bone loss in 17. Average clinical follow-up was 6.5 years. Results Excellent or satisfactory results were achieved in 21 of 35 shoulders. No components met criteria to be considered radiographically at risk for clinical loosening. Intraoperative complications included an unrecognized nondisplaced diaphyseal fracture that later displaced in 1 shoulder. Late complications included deep infection in 1 and fracture nonunion in 1. Conclusions Intermediate or long-stemmed humeral components proved useful in obtaining a secure distal fit in patients with a large humeral canal or in those with significant proximal bone loss. Worse clinical results were achieved in those with bone loss. Radiographic follow-up shows these components are at a low risk for loosening.
Value-based healthcare delivery models are becoming increasingly common and are driving cost effectiveness initiatives. Rotator cuff repair (RCR) is a commonly performed procedure with some ...variations on the specific surgical technique. The purpose of this study was to perform a comprehensive analysis of the cost, complications, and readmission rates of 3 categories of RCR techniques (open oRCR, combined arthroscopically assisted and mini-open CRCR, and all arthroscopic ARCR) at a high-volume institution.
All RCR procedures performed by 2 fellowship-trained shoulder surgeons at a single institution between 2012 and 2017 were retrospectively identified. These consisted of oRCR, CRCR, and ARCR repair techniques. One surgeon performed oRCR and CRCR, and the second surgeon performed ARCR. A cost analysis was designed to include a period of 60 days preoperatively, the index surgical hospitalization, and 90 days postoperatively, including costs of any readmission or reoperation.
The cohort consisted of 95 oRCR, 233 CRCR, and 287 ARCR. Median standardized costs were as follows: preoperative evaluation $486.03; index surgical hospitalization oRCR $9,343.10, CRCR $10,057.20, and ARCR $10,330.60; and postoperative care $875.02. Preoperative and postoperative costs did not vary based on the type of RCR performed. However, significant differences were observed among index surgical costs (P = .0008). The highest standardized cost for hospitalization for both the CRCR group and the ARCR group was related to the cost of the operating room and the implants. The 90-day complication, reoperation, and readmission rates were 1.1%, 1.1%, and 2.1% in the open group; 0.8%, 0.8%, and 1.7% in the combination group; 0%, 0%, and 1.7% in the all arthroscopic group, respectively. There were no significant differences among the 3 surgical procedures with respect to complication (P = .26), reoperation (P = .26), and readmission rates (P = .96).
In this investigation, the median standardized costs for RCR inclusive of 60-day workup and 90-day postoperative care were $10,704.15, $11,418.25, and $11,691.65 for oRCR, CRCR (average added cost $714.10), and ARCR (added cost $987.50), respectively. The group complication, reoperation, and readmission rate were 0.5%, 0.5%, and 1.8% with no significant differences between the varying techniques, respectively. This retrospective cost analysis and complication profile may serve as a useful reference as surgeons consider engaging in bundled payment for RCR. As value based initiatives continue to progress, implant cost may serve as an actionable area for cost reduction.
Background Currently, there is little information on the benefits and problems associated with long-stem humeral components in shoulder arthroplasty. This study examined the frequency of use, ...indications, complications, and security of fixation using a long-stem humeral component in revision shoulder arthroplasty. Materials and methods Eighty revision shoulder arthroplasties were monitored clinically for at least 2 years or until repeat revision surgery. The primary indications for use of an intermediate or long stem were proximal bone loss in 40, nonunion in 14, a malpositioned previous stem with bone loss in 10, an acute intraoperative fracture in 7, an acute preoperative periprosthetic fracture in 5, diaphyseal bone loss in 2, and a box-shaped osteotomy to remove a well-fixed stem in 2. Clinical follow-up was an average of 5.9 years, and radiographic follow-up was an average of 4.7 years. Results Intraoperative complications included fracture removing the previous stem in 5, a cortical perforation in 6, and cement extrusion in 7. Late complications included fracture nonunion in 5, deep infection in 2, and component loosening in 1. One component met criteria to be considered radiographically “at risk” for clinical loosening. Conclusions Long-stem humeral components are useful to obtain secure fixation in healthy bone in revision shoulder arthroplasty in patients with proximal bone loss, diaphyseal fracture, or a previously malpositioned stem. Complications are frequent, and caution should be taken to avoid intraoperative fractures, distal cortical perforation, or cement extrusion. These components are at low risk for loosening.
Background The aim of this study was to determine the optimal repair configuration for anterior shoulder instability after a labral tear. Materials and methods Nine fresh, frozen shoulders were used. ...With a 50-N axial force, the humeral head was translated anteriorly, and the translational force was measured. The measurement was performed with the capsule intact, after creating a Bankart lesion, and after the Bankart repair at 5 different positions: glenoid rim, glenoid surface-2 mm (on the glenoid surface 2 mm from the glenoid rim), glenoid surface-5 mm, scapular neck-2 mm (on the scapular neck 2 mm from the glenoid rim), and scapular neck-5 mm. Glenoid rim fixation was done with and without a “bumper.” The “bumper” was created by plicating the capsule to form a thickened mass of tissue. Results The translational force was restored to the intact level after the glenoid rim fixation. However, there was no significant difference in force after the Bankart repair with and without a “bumper” nor after the glenoid rim fixation and glenoid surface-2 mm. The force significantly decreased after scapular neck-2 mm and scapular neck-5 mm compared with the glenoid rim fixation. Conclusion The anchor fixation on the glenoid face does not increase the translational force compared with the glenoid rim placement, but the placement on the scapular neck decreases the translational force.
Background Shoulder arthroplasty after native shoulder infection is an uncommon problem with limited outcomes data. The purpose of this study was to evaluate the rates of reinfection and clinical ...outcomes after shoulder arthroplasty for the treatment of postinfectious glenohumeral arthritis. Methods Between 1977 and 2009, 24 shoulders underwent shoulder arthroplasty for postinfectious glenohumeral arthritis. Twenty-three were monitored for a minimum of 2 years (mean, 8.3 years) or until reoperation. Complications and clinical and radiographic results were documented at the most recent follow-up. Results Of the 23 shoulders, 23 had no pain or mild or moderate pain after vigorous activity. Pain scores improved from 4.5 to 2.1 points after shoulder arthroplasty ( P < .001). The mean shoulder abduction improved from 62° to 110° ( P < .001), and the mean external rotation improved from 14° to 47° ( P < .001). Subjectively, the result in 16 of the 23 shoulders was rated as much better or better. Five shoulders required reoperation, with 2 having an infectious cause. The Neer rating was excellent in 2 shoulders, satisfactory or successful in 9, and unsatisfactory or unsuccessful in 12. Radiographic follow-up showed 3 glenoids and 3 humeral components were at risk for loosening. Conclusions Shoulder arthroplasty for the treatment of the sequelae of an infected shoulder can be performed with a low risk of reinfection. The higher-than-expected rate of clinical or radiographic loosening remains concerning for culture negative infection. Although overall pain and motion can be expected to improve, unsatisfactory clinical results are not uncommon and may be secondary to the initial insult of infection.
Background Humeral head variations were developed based on anatomic and biomechanical advantages; however, the effect of this expanded prosthetic inventory has yet to be investigated clinically. This ...study seeks to determine whether prosthetic variety has led to better outcomes, has led to similar outcomes facilitating joint reconstruction, or created any unanticipated complications. Methods One hundred sixty primary total shoulder arthroplasties were performed for osteoarthritis. Patients received 52 standard, 60 eccentric, and 48 offset humeral heads. Head geometry was selected intraoperatively during trialing based on a complementing relationship to the glenoid throughout a near-normal range of motion. Patients had 2 years of follow-up or follow-up until reoperation (mean, 4.7 years; range, 0.8-8.3 years). Results Mean pain scores decreased from 4.5 to 1.9 on a 5-point scale ( P < .001), mean elevation increased from 94° to 150°, mean external rotation increased from 22° to 57° ( P < .001), larger lucent lines (≥1.5 mm) or change in glenoid position occurred around 19 components, and survivorship was 98% (95% confidence interval, 97%-100%) at 1 year and 98% (95% confidence interval, 95%-100%) at 5 years. No difference among head configurations was found for any of these outcomes. Conclusions Evolution of designs has provided options to more accurately re-create anatomy including changes caused by osteoarthritis. At the length of follow-up in this study, clinical outcomes, radiographic performance, and survivorship are equivalent when applying these humeral head variations, and no special complications have developed.
PDF
