Perianchor Cyst Formation Is Similar Between All-Suture and Conventional Suture Anchors Used for Arthroscopic Rotator Cuff Repair in the Same Shoulder.

Purpose: The purpose of this study was to compare perianchor cyst formation between soft and hard suture anchors placed in the same patient 1 year after arthroscopic rotator cuff repair (ARCR). Methods: This study reviewed patients who underwent primary ARCR using a "hybrid" technique using at least one soft anchor (FiberTak, Arthrex, Naples, FL) and one hard anchor (SwiveLock) placed in the same shoulder between January 1, 2018 and December 31, 2018. Magnetic resonance imaging was obtained at minimum 1-year postoperative to assess cyst formation (perianchor fluid signal) and rotator cuff healing. Range of motion (ROM) and patient-reported outcome measures (PROMs) were evaluated at baseline and 1-year follow up. PROMs included visual analog scale pain score, Simple Shoulder Test score, American Shoulder and Elbow Surgeon (ASES) score. Results: Nineteen patients with a combined 45 hard and 26 soft suture anchors were available for follow-up at a mean of 20 months postoperatively. There was a higher proportion of grade 1 fluid signal changes in the hard anchor group compared to the soft group (62.2% to 7.7; P < .001); however, there was no difference in the incidence of cyst formation (grade 2 or 3 changes) between groups (13.3% vs 3.8%; P = .251). There was also no difference in the rate of cyst formation between biocomposite and polyether-ether-ketone-type hard anchors (18.2% vs 0%; P = .113) or between anchors placed at the greater and lesser tuberosities (10.2% vs 5.3%, P = .519). Conclusion: Hard suture anchors showed increased fluid signal compared to soft suture anchors at short-term follow-up after ARCR, but there was no difference in cyst formation between anchor types.

Why patients fail to achieve a Patient Acceptable Symptom State (PASS) after total shoulder arthroplasty?

BACKGROUND: The purpose of this study was to compare patient-reported outcomes (PROs) and range of motion (ROM) measurements between patients achieving and failing to achieve a Patient Acceptable Symptom State (PASS) after anatomic total shoulder arthroplasty (TSA) to determine which PRO questions and ROM measurements were the primary drivers of poor outcomes. METHODS: A retrospective review of a multicenter database identified 301 patients who had undergone primary TSA between 2015 and 2018 with ROM and PRO data recorded preoperatively and at a minimum of two years postoperatively. The primary outcome was the difference in active ROM between patients achieving and failing to achieve the PASS threshold for the American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores. The secondary outcome was the difference in self-reported pain levels between those achieving and failing to achieve a PASS. RESULTS: Based on the ASES PASS threshold, 87% (261/301) of patients achieved a PASS after TSA, whereas 13% did not. Based on the SANE PASS threshold, 69% (208/301) of patients achieved a PASS after TSA, whereas 31% did not. Patients who failed to achieve a PASS after TSA were younger and had lower short form-12 mental health scores than those who did. There was a significant difference in pain between those who achieved and failed to achieve a PASS after TSA (ASES PASS current shoulder pain 16.5% vs. 95%, P < .001, SANE PASS current shoulder pain 13% vs. 58.1%, P < .001). Those failing to reach a PASS had significantly higher pain levels (ASES PASS Visual Analog Scale pain scores [4.2 vs. 0.4, P < .001] and SANE PASS Visual Analog Scale pain scores [2.0 vs. 0.4, P < .001]) and worse function in nearly all domains of the ASES and Western Ontario Osteoarthritis of the Shoulder index after surgery. There was little difference in ROM between those reaching and failing to reach a PASS (no difference in active external rotation with the arm adducted, active internal rotation at the nearest spinal level, or active internal rotation with the shoulder abducted to 90 degrees for ASES and SANE PASS). CONCLUSION: There is variability in the percentage of patients who achieve a PASS after TSA, ranging from 69% to 87% depending on the PRO used to define the threshold. Patients who did not achieve a PASS after TSA were significantly more likely to have pain, whereas there were very few differences in ROM, indicating pain as the primary driver of failing to achieve a PASS. Setting realistic postoperative expectations for pain relief may be important for improving patient-reported results after TSA.

Five-year radiographic evaluation of stress shielding with a press-fit standard length humeral stem.

BACKGROUND: Stress shielding of the humeral stem is a known complication in press-fit total shoulder arthroplasty (TSA), but there remain limited data on its prevalence and clinical impact in midterm follow-up. The purpose of this study was to determine the prevalence of humeral stem stress shielding and its impact on functional outcomes at minimum 5-year follow-up in standard length press-fit TSA. The hypothesis was that the presence of stress shielding at minimum 5-year follow-up would not affect functional outcome scores or range of motion (ROM). METHODS: A multicenter retrospective review of primary TSAs performed with a press-fit standard length humeral stem. Functional outcome scores, ROM, and radiographs were reviewed at minimum 5-year follow-up. Prevalence of stress shielding was determined by presence of medial calcar osteolysis and adaptive changes. Function was assessed with the visual analog scale (VAS) pain score, Simple Shoulder Test (SST) score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, and Single Assessment Numeric Evaluation (SANE) score, and ROM. RESULTS: Forty-seven patients with 47 TSAs were available for follow-up at a mean of 79 months postoperation. Overall, 15 of 47 humeral stems had high adaptive change scores (31.9%), and 20 demonstrated medial calcar osteolysis (42.6%). Stems with evidence of stress shielding showed no significant change in SST, VAS, ASES, or SANE scores and minimal change in ROM measurements at minimum 5-year follow-up. CONCLUSION: Stress shielding is common at midterm follow-up in press-fit TSA but does not appear to affect functional outcomes.

Minimum 5-year outcomes of pegged versus keeled all-polyethylene glenoids.

BACKGROUND: Glenoid loosening remains one of the most common concerns at mid- to long-term follow-up after total shoulder arthroplasty (TSA). Pegged and keeled designs have been compared at short-term follow-up, but few studies have compared outcomes at mid-term follow-up. Our purpose was to compare minimum 5-year outcomes of pegged and keeled cemented, all-polyethylene glenoids in TSA. The hypothesis was that no difference in functional outcomes or loosening would be found between the 2 components. METHODS: We performed a multicenter retrospective study of TSAs with either a pegged or keeled cemented glenoid. At a minimum of 5 years postoperatively, functional outcomes and radiographic loosening were compared. RESULTS: Forty-seven TSAs were available for follow-up, including 20 pegged and 27 keeled components, at a mean of 79 months (range, 60-114 months) postoperatively. Overall, functional outcomes improved in both groups from preoperatively to postoperatively, and no difference was found between the 2 groups. Radiographic glenoid loosening (score ≥ 3) was observed in 9 of 27 keeled glenoids (33.3%) compared with 5 of 20 pegged glenoids (25%) (P = .54). Loosening was associated with lower postoperative forward flexion (P = .026), lower American Shoulder and Elbow Surgeons scores (P = .030), and higher visual analog scale pain scores (P = .007). CONCLUSION: Radiographic glenoid loosening of a cemented, all-polyethylene component was associated with decreased functional outcomes at minimum 5-year follow-up of TSAs. However, this study showed no difference in loosening rates between keeled and pegged components.

Prevalence of vitamin D deficiency in sickle cell disease: a systematic review.

Vitamin D deficiency has emerged as a public health focus in recent years and patients with sickle cell disease (SCD) reportedly have a high prevalence of the condition. Our objectives were to summarize definitions of vitamin D deficiency and insufficiency used in the literature, and to determine the prevalence and magnitude of each in patients with SCD through a systematic review conducted according to PRISMA guidelines. From a PubMed search, 34 potential articles were identified and 15 met eligibility criteria for inclusion. Definitions of deficiency and insufficiency varied greatly across studies making direct comparisons difficult. This review provides evidence to suggest that suboptimal vitamin D levels are highly prevalent among those with SCD, far more so than in comparable non-SCD patients or matched control populations. Defining deficiency as vitamin D < 20 ng/mL, prevalence estimates in SCD populations range from 56.4% to 96.4%. When compared with results from the population-based National Health and Nutrition Examination Survey, however, the general African American population appeared to have a similarly high prevalence of vitamin D deficiency. African American patients with and without SCD were both substantially higher than that of Caucasians. What remains to be determined is whether there are adverse health effects for patients with SCD because of concurrent vitamin D deficiency.