High rate of clinically relevant improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis

BACKGROUND The minimal clinically important difference(MCID)is defined as the smallest meaningful change in a health domain that a patient would identify as important.Thus,an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient.AIM To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis.METHODS Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital,Denmark.The patients were evaluated preoperatively and 3 months,6 months,12 months,and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index(WOOS),Oxford Shoulder Score(OSS)and Constant-Murley Score(CMS).The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID.Based on previous literature,MCID for WOOS,OSS,and CMS were defined as 12.3,4.3,and 12.8 respectively.RESULTS Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis.Mean age at the time of surgery was 66 years(range 49.0-79.0,SD:8.3)and 65%were women.One patient was revised within the two years follow-up.The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points[95%confidence interval(95%CI):39.7-53.3,P<0.005]for WOOS,18.2 points(95%CI:15.5-21.0,P<0.005)for OSS and 37.8 points(95%CI:31.5-44.0,P<0.005)for CMS.Two years postoperatively,41 patients(87%)had an improvement in WOOS that exceeded the MCID,45 patients(94%)had an improvement in OSS that exceeded the MCID,and 42 patients(88%)had an improvement in CMS that exceeded the MCID.CONCLUSION Based on three shoulder-specific outcome measures we find that approximately 90%of patients has a clinically relevant improvement.This is a clear message when informing patients about their prognosis.

Efficacy and safety of intravenous tranexamic acid in total shoulder arthroplasty:A meta-analysis

BACKGROUND Total shoulder arthroplasty(TSA)results in a large amount of perioperative blood loss due to severe trauma.AIM To investigate the safety and efficacy of intravenous tranexamic acid(TXA)in TSA.METHODS We searched the PubMed,Cochrane Library,Embase and Web of Science databases for randomized controlled trials(RCTs)on the use of TXA in TSA.And all the results were checked and assessed by Reference Citation Analysis(https://www.referencecitationanalysis.com/).A meta-analysis was performed with Review Manager 5.3 to calculate the odds ratio(OR)or weighted mean difference(WMD)of related outcome indicators.RESULTS A total of 5 RCTs with level 1 evidence were included.There were 369 cases,with 186 in the TXA group and 183 in the placebo group.The meta-analysis showed that TXA can significantly reduce total blood loss during the perioperative period[WMD=-249.56,95%confidence interval(CI):-347.6 to-151.52,P<0.0001],and the incidence of adverse reactions was low(OR=0.36,95%CI:0.16-0.83,P=0.02).Compared with the placebo group,the TXA group had significantly less total haemoglobin loss(WMD=-34.39,95%CI:-50.56 to-18.22),less haemoglobin fluctuation before and after the operation(WMD=-0.6,95%CI:-0.93 to-0.27)and less 24-h drain output(WMD=-136.87,95%CI:-165.87 to-106.49).There were no significant differences in the operation time(P=0.11)or hospital length of stay(P=0.30)between the two groups.CONCLUSION The application of intravenous TXA in the perioperative period of TSA can significantly reduce the total volume of perioperative blood loss and reduce the incidence of adverse reactions,so TXA is worthy of widespread clinical use.

A Retrospective Comparison of Interscalene Continuous Catheter Verse Single-Injection with Liposomal Bupivacaine in Total Shoulder Arthroplasty

Background: One common method of pain control for total shoulder arthroplasty is long-duration delivery of local anesthetic via interscalene brachial plexus block (ISB) with a continuous catheter. Alternatively, liposomal bupivacaine has also been administered as an ISB as a means to prolong the analgesic effect. This study was completed to measure the non-inferiority of single-injection ISB with liposomal bupivacaine compared with ISB continuous catheter for total shoulder arthroplasty. Methods: We performed a retrospective chart review of patients who underwent total shoulder arthroplasty using either an ISB continuous catheter or a single injection ISB with liposomal bupivacaine for post operative analgesia. The primary goal of this study was to determine if single-injection with liposomal bupivacaine conferred non-inferior pain scores compared to the continuous catheter. Secondary outcomes evaluated oxygen saturation as a measure of hemidiaphragmatic paresis, post operative opioid requirements, and difference in cost. Results: We identified 333 patients for the study: 126 received continuous catheter and 207 received single-injection with liposomal bupivacaine. The median length of stay was 1 day. Pain scores for those treated with single-injection with liposomal bupivacaine were non-inferior to pain scores of those treated with the continuous catheter on post-op days 0, 1 and 2. Pain scores were lower for single-injection with liposomal bupivacaine patients on days 3 and 4, however they did not reach statistical significance. There was no significant difference in oxygen saturation between the two groups. Both groups had similar daily morphine milligram equivalent requirements. Liposomal bupivacaine ISB was also found to be less expensive. Conclusion: Single-injection ISB with liposomal bupivacaine provides non-inferior analgesia at a reduced cost compared with continuous catheter ISB for total shoulder arthroplasty.

Simultaneous bilateral acromial base fractures after staged reverse total shoulder arthroplasty: A case report

BACKGROUND Acromial and scapular spine fractures after reverse total shoulder arthroplasty(RTSA)are a well-known complication that may negatively impact the effects of long-term outcomes.However,to the best of our knowledge,there has been no report of simultaneous bilateral fractures of the acromion or scapular spine that occurred following staged RTSA.CASE SUMMARY A 79-year-old right-handed male visited our outpatient clinic with a chief complaint of pain and limited motion of both shoulder joints for a one-year duration.Based on plain radiographs and magnetic resonance images,the preoperative diagnosis was bilateral cuff tear arthropathy with failed rotator cuff repair.This patient was treated with staged bilateral RTSA at a two-month interval.At 5 and 3 mo after right and left side surgery,the patient returned to the outpatient clinic with severe pain and limited motion of both shoulder joints for 2 wk without a traumatic event.A computed tomography scan revealed nondisplaced acromial base fractures of both shoulders.Considering bilateral involvement,fracture location,and patient’s demand,open reduction and internal fixation(ORIF)using plate for bilateral acromial base fractures were performed.At 2 years after ORIF,the fracture was completely healed,and the patient was satisfied with shoulder status.CONCLUSION This report describes an extremely rare case of simultaneous bilateral acromial base fractures after staged RTSA managed successfully by ORIF with a precontoured plate designed for distal clavicle fractures.Although acromial fracture after RTSA can be treated conservatively,simultaneous bilateral fractures may warrant surgical intervention as a means of addressing difficulties in activities of daily living.

Return to work following shoulder arthroplasty:A systematic review

BACKGROUND Many patients prioritize the ability to return to work(RTW)after shoulder replacement surgeries such as total shoulder arthroplasty(TSA),reverse TSA(rTSA),and shoulder hemiarthroplasty(HA).Due to satisfactory clinical and functional long-term outcomes,the number of shoulder replacements performed will continue to rise into this next decade.With younger individuals who compose a significant amount of the workforce receiving shoulder replacements,patients will begin to place a higher priority on their ability to RTW following shoulder arthroplasty.AIM To summarize RTW outcomes following TSA,rTSA,and HA,and analyze the effects of workers’compensation status on RTW rates and ability.METHODS This systematic review and analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A literature search regarding RTW following shoulder arthroplasty was performed using four databases(PubMed,Scopus,Embase,and Cochrane Library),and the Reference Citation Analysis(https://www.referencecitationanalysis.com/).All studies in English relevant to shoulder arthroplasty and RTW through January 2021 that had a level of evidence I to IV were included.Nonclinical studies,literature reviews,case reports,and those not reporting on RTW after shoulder arthroplasty were excluded.RESULTS The majority of patients undergoing TSA,rTSA,or HA were able to RTW betweenone to four months,depending on work demand stratification.While sedentary or light demand jobs generally have higher rates of RTW,moderate or heavy demand jobs tend to have poorer rates of return.The rates of RTW following TSA(71%-93%)were consistently higher than those reported for HA(69%-82%)and rTSA(56%-65%).Furthermore,workers’compensation status negatively influenced clinical outcomes following shoulder arthroplasty.Through a pooled means analysis,we proposed guidelines for the average time to RTW after TSA,rTSA,and HA.For TSA,rTSA,and HA,the average time to RTW regardless of work demand stratification was 1.93±3.74 mo,2.3±2.4 mo,and 2.29±3.66 mo,respectively.CONCLUSION The majority of patients are able to RTW following shoulder arthroplasty.Understanding outcomes for rates of RTW following shoulder arthroplasty would assist in managing expectations in clinical practice.

Transfer Learning-Based Class Imbalance-Aware Shoulder Implant Classification from X-Ray Images

Total shoulder arthroplasty is a standard restorative procedure practiced by orthopedists to diagnose shoulder arthritis in which a prosthesis replaces the whole joint or a part of the joint.It is often challenging for doctors to identify the exact model and manufacturer of the prosthesis when it is unknown.This paper proposes a transfer learning-based class imbalance-aware prosthesis detection method to detect the implant’s manufacturer automatically from shoulder X-ray images.The framework of the method proposes a novel training approach and a new set of batch-normalization,dropout,and fully convolutional layers in the head network.It employs cyclical learning rates and weighting-based loss calculation mechanism.These modifications aid in faster convergence,avoid local-minima stagnation,and remove the training bias caused by imbalanced dataset.The proposed method is evaluated using seven well-known pre-trained models of VGGNet,ResNet,and DenseNet families.Experimentation is performed on a shoulder implant benchmark dataset consisting of 597 shoulder X-ray images.The proposed method improves the classification performance of all pre-trained models by 10–12%.The DenseNet-201-based variant has achieved the highest classification accuracy of 89.5%,which is 10%higher than existing methods.Further,to validate and generalize the proposed method,the existing baseline dataset is supplemented to six classes,including samples of two more implant manufacturers.Experimental results have shown average accuracy of 86.7%for the extended dataset and show the preeminence of the proposed method.