An objective assessment of the impact of tendon retraction on sleep efficiency in patients with full-thickness rotator cuff tears: a prospective cohort study.

BACKGROUND: Sleep quality, quantity, and efficiency have all been demonstrated to be adversely affected by rotator cuff pathology. Previous measures of assessing the impact of rotator cuff pathology on sleep have been largely subjective in nature. This study was undertaken to objectively analyze this relationship through the use of activity monitors. METHODS: Patients with full-thickness rotator cuff tears at a single institution were prospectively enrolled between 2018 and 2020. Waistworn accelerometers were provided for the patients to use each night for 14 days. Sleep efficiency was calculated using the ratio of the time spent sleeping to the total amount of time that was spent in bed. Retraction of the rotator cuff tear was classified using the Patte staging system. RESULTS: This study included 36 patients: 18 with Patte stage 1 disease, 14 with Patte stage 2 disease, and 4 patients with Patte stage 3 disease. During the study, 25 participants wore the monitor on multiple nights, and ultimately their data was used for the analysis. No difference in the median sleep efficiency was appreciated amongst these groups (P>0.1), with each cohort of patients demonstrating a generally high sleep efficiency. CONCLUSIONS: The severity of retraction of the rotator cuff tear did not appear to correlate with changes in sleep efficiency for patients (P>0.1). These findings can better inform providers on how to counsel their patients who present with complaints of poor sleep in the setting of full-thickness rotator cuff tears. Level of evidence: Level II.

Predictors of Success With Chronic Antibiotic Suppression for Prosthetic Joint Infections.

BACKGROUND: Management of recurrent prosthetic joint infection (PJI) after attempted surgical eradication remains a challenge. Chronic antibiotic suppression (CAS) is regarded as a reasonable treatment option for select patients with persistent infection or multiple comorbidities. The study seeks to compare cohorts who succeed and fail with CAS. METHODS: This retrospective cohort study assesses patients who were treated with CAS for a PJI. Patients were included if they had a culture-proven PJI and received chronic suppressive antibiotics. Failure of suppression was defined as reoperation after initiating CAS or death occurring as result of infection. A Cox proportional hazards multivariate regression model was used to estimate risk of reoperation as a function of risk factors related to patient comorbidities, surgical history, affected joint, and infecting organism. RESULTS: We identified 45 PJIs (31 knees, 14 hips) managed with CAS with a median follow-up of 50 (95% confidence interval [CI] 33.61-74.02) months. The overall success rate of managing PJI with CAS was 67% (30/45). Controlling for body mass index and Gram status of the organism, total hip arthroplasty patients were less likely than total knee arthroplasty patients to require reoperation (hazard ratio 0.18, 95% CI 0.01-0.96, P = .04). Patients with Gram-positive infections were less likely than those with a Gram-negative infections to require reoperation (hazard ratio 0.22, 95% CI 0.05-0.88, P = .03). Severe antibiotic side effects were rare. Patients who experienced multiple changes to their antibiotic regimen were more likely to fail with CAS. CONCLUSION: CAS is a reasonable strategy in patients with PJI who lack or refuse further surgical treatment options. Most hips and Gram-positive infections treated with CAS successfully avoided reoperation in this cohort.

Intraoperative Efficiency in Contemporary Total Shoulder Arthroplasty: Is Manual Pressure During Cement Curing Still Necessary With Interference Fit Pegged Glenoids?

INTRODUCTION: No previous data have demonstrated the effect of manual pressure during cement curing on interference-fit glenoid implant fixation in total shoulder arthroplasty. In this study, we examined cement mantle characteristics and implant seating using two different methods of securing an interference-fit glenoid implant with peripheral cemented pegs: a manual pressure technique versus a pressureless technique. METHODS: Sixteen cadaveric scapulae were harvested, and their glenoids were prepared for component insertion. Glenoids with an interference-fit central peg were cemented into the peripheral holes and fully seated. Two techniques were employed during cement curing: (1) a manual pressure technique (8 glenoids), which used a static 70 N load application to each implant for 10 minutes; and (2) a pressureless technique (8 glenoids), which used no pressure application, and the implant was left to set without intervention. Each glenoid was subsequently imaged using microcomputed tomography and analyzed for differences in cement mantle characteristics and implant seating. RESULTS: The mean area of cement penetration for the manual pressure technique was not statistically different from the pressureless group (P = .26, valid N = 288). The average implant incongruity after final seating in the manual pressure group was 0.63 mm, compared with 1.0 mm in the pressureless group. A linear mixed effects model with a Kenward-Roger correction was used to compare the two groups, and no significant difference was found (Mdiff = -0.386, 95% confidence interval: -0.978 to 0.206; P = 0.17). CONCLUSION: Manual pressure of the glenoid component during cement curing yielded no difference in the cement mantle area or final implant seating incongruity compared with a pressureless technique. This knowledge could potentially benefit both the surgeon and the patient by increasing the efficiency in total shoulder arthroplasty surgery.

Platelet-rich plasma and the shoulder: clinical indications and outcomes.

PURPOSE OF REVIEW: The orthopedic community has seen a rapid rise in the clinical use of platelet-rich plasma (PRP) in the management of shoulder pathologies over the past decade. The purpose of this paper is to review the current literature regarding the indications and outcomes of PRP for the surgical and non-surgical management of common shoulder pathologies, including rotator cuff tears. RECENT FINDINGS: Multiple studies have been published recently regarding the use of PRP for the operative and non-operative treatment of rotator cuff tears. There has been less research published on the use of PRP in the management of other conditions of the shoulder. Despite attempts to standardize and classify PRP formulations, there remains great variation in the inter- and intra-subjection composition, preparation, and administration techniques of PRP, limiting the conclusions that can be drawn regarding the utility and effectiveness of this biologic treatment as reported by Mazzocca et al. (J Bone Joint Surg Am. 94(4):308-16, 2012). Recent literature has shown equivocal to minor benefit of PRP use for shoulder pain, function, and healing. While few complications have been reported and PRP administration appears to carry little risk to the patient, the body of literature is currently inconclusive regarding the clinical benefit and cost-effectiveness of PRP in the treatment of shoulder pathology. As for PRP use specifically as an adjunct to surgical rotator cuff repairs, there is no clear consensus on its effectiveness in either clinical or structural outcomes. To further delineate the efficacy of PRP for shoulder pathology, it is essential that more double-blinded, randomized controlled investigations with large sample sizes and standardized PRP preparations be performed.