Posterior approach shoulder arthroplasty: a cadaveric study assessing access.

BACKGROUND: Posterior shoulder arthroplasty is an approach to shoulder replacement. The goal of this cadaveric study was to determine anatomic feasibility for posterior approach shoulder arthroplasty by evaluating access to the glenoid, humerus, and canal. METHODS: Twelve fresh frozen shoulders (10 males; 2 females) (mean age, 76 [range, 55-92 years]; weight, 79 kg [range, 34-125 kg]) were used. Traditional exposure techniques and retractors were used to evaluate direct access. Exposure to the glenoid and humerus was evaluated using digital imaging software. Successful placement from stemmed arthroplasty was evaluated using digital radiographs and imaging software. RESULTS: The posterior approach permitted direct access to 88.8% ± 8.1% of the glenoid. There was access to the center of the humeral head cut surface in 12 of 12 specimens. In 10 specimens, there was 100% access to the entire cut surface of the humerus and peripheral edges. The average access to the humerus was 95.3% ± 13.4%. Average angulation with stem placement was 0.73° of varus (range, 4.4° of varus to 3.5° of valgus). Regarding lateral plane angulation, there was an average of 0.33° of posterior angulation (range, 3.3° of posterior angulation to 2.5° of anterior angulation). CONCLUSION: Access to the center of the glenoid and humerus was achieved in all cases. More research is needed to evaluate the clinical efficacy of posterior shoulder arthroplasty, including mid- and long-term outcome and safety studies.

Resiliency influences postoperative outcomes following rotator cuff repair.

BACKGROUND: The purpose of this retrospective review was to assess the effects of resiliency on postoperative outcome scores and complications following rotator cuff repair (RCR). METHODS: In 2014, 49 consecutive patients underwent arthroscopic RCR for either a partial- or full-thickness tear performed by a single surgeon at a multi-location, single center. In these patients, the following scores were monitored: American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), and Life Orientation Test-Revised (LOT-R). Data collected at 4 years postoperatively were statistically analyzed by 1-way analysis of variance tests, Pearson correlations, and multivariate tests of between-subjects effects (multivariate analysis of covariance). RESULTS: There was a statistically significant difference between cohorts and their scores of resiliency and optimism measured by the LOT-R (function portion of ASES score [ASESf], P = .048; pain portion of ASES score [ASESp], P = .003; and SST score, P = .009) as illustrated by a 1-way analysis of variance. A multivariate analysis of covariance found that LOT-R scores exhibited a significant impact on outcome scores (ASESf score, P = .043; ASESp score, P = .002; and SST score, P = .007). Correlational analysis indicated that LOT-R scores directly correlated with higher ASESp (P = .003), ASESf (P = .029), and SST (P = .018) scores. Regression line analysis provided a positive coefficient of determination value for all outcome scores. CONCLUSION: The premise of this study was to look at mental resilience as a potential indicator of long-term outcome scores following RCR. The results of statistical analysis indicated that outcome scores are significantly different based on the degree of optimism; high levels of optimism impact and correlate to higher outcome scores. This study provides a basis for future studies of psychological resilience in the field of orthopedic surgery.

Posterior Approach Total Shoulder Arthroplasty: A Retrospective Analysis of Short-term Results.

Subscapularis dysfunction and failure are the leading causes of complications of total shoulder arthroplasty (TSA). An approach to shoulder arthroplasty has been described that may improve exposure to the retroverted glenoid and spare the rotator cuff. This article details the 6-month clinical outcomes of the first 26 patients who underwent TSA using a posterior approach. Thirty-one patients who underwent TSA using a posterior approach between September 2016 and October 2017 were identified retrospectively. Patients were assessed for American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST) scores, range of motion, complications, radiographic outcomes, and patient satisfaction. Statistical models were used to compare the means for each outcome variable over time. Of the initial 31 patients, 26 patients were available for follow-up at a minimum of 6 months; the remaining 5 patients did not return for follow-up at 6 months. Significant improvement in each outcome variable from baseline was noted by 6 weeks postoperatively. Further improvement was observed at 3 months for SST and external rotation, and at 6 months for ASES function and forward flexion. All outcome variables demonstrated some improvement from one time point to the next. Posterior TSA is a safe and efficacious procedure at 6 months. Compared with traditional TSA, posterior cuff-sparing approaches may improve posterior joint access, posterior soft tissue balancing, and long-term rotator cuff issues. [Orthopedics. 2020; 43(1):e15-e20.].

Improving Orthopedic Patient Outcomes: A Model to Predict 30-Day and 90-Day Readmission Rates Following Total Joint Arthroplasty.

BACKGROUND: Over the next 10-15 years, there is expected to be an exponential increase in the number of total joint arthroplasties in the American population. This, combined with rising costs of total joint arthroplasty and more recent changes to the reimbursement payment models, increases the demand to perform quality, cost-effective total joint arthroplasties. The purpose of this study is to build models that could be used to estimate the 30-day and 90-day readmission rates for patients undergoing total joint arthroplasty. METHODS: A retrospective review of patients admitted to a single hospital, over the course of 56 months, for total joint arthroplasty was performed. The goal is to identify patients with readmission in a 30-day or 90-day period following discharge from the hospital. Binary logistic regression was used to build predictive models that estimate the likelihood of readmission based on a patient's risk factors. RESULTS: Of 5732 patients identified for this study, 237 were readmitted within 30 days, while 547 were readmitted within 90 days. Age, body mass index, gender, discharge disposition, occurrence of cardiac dysrhythmias and heart failure, emergency department visits, psychiatric diagnoses, and medication counts were all found to be associated with 30-day admission rates. Similar associations were found at 90 days, with the exclusion of age and psychiatric drug use, and the inclusion of intravenous drug abuse, narcotic medications, and total joint arthroplasty within 12 months. CONCLUSION: There are patient variables, or risk factors, that serve to predict the likelihood of readmission following total joint arthroplasty.