Reverse Shoulder Arthroplasty without Bone-Grafting for Severe Glenoid Bone Loss in Patients with Osteoarthritis and Intact Rotator Cuff: Concise Follow Up at Minimum of Five Years, of Previous Report

Prashant Meshram,Stephen Weber,Jorge Rojas,Jacob Joseph,Uma Srikumaran,Edward McFarland 대한견주관절의학회 2021 대한견주관절학회 학술대회논문집 Vol.2021 No.3

Introduction and Background When performing reverse shoulder arthroplasty in patients with limited glenoid bone, one of the treatment options is to ream the glenoid flat without bone grafting. The purpose of this study was to evaluate the clinical outcomes of this technique in a previously reported cohort after a minimum of 5 years. Material and Method Survival was defined as revision for any cause or baseplate failure with evidence of loosening. Clinical results at follow up were evaluated using patient related outcome scores (PROs) including VAS for pain and range of motion. Radiographic evaluation included scapula notching and baseplate loosening. Results Of the original cohort of 42 patients, 7 had died and 4 were lost to follow up. The remaining 29 patients (31 shoulders) were contacted for follow up at a minimum of 5 years (range, 60 to 141 months). Implant survivorship in those patients at a minimum of 60 months was 97%. If one includes the 1patient who had a failed RTSA prior to 2 years, the overall survivorship at 5 year follow up was 94%. The patients who did not have an implant failure had statistically and clinically significant differences from preoperative to postoperative for the VAS for pain, ASES score, the Simple Shoulder Test, and the SF-36 (Table 1). Radiographic evaluation demonstrated notching in 6 patients (19%) with 2 with grade 1 notching, 2 with grade 2 notching, 1 with grade 3 notching, and 1 with grade 4 notching. Conclusions For patients with osteoarthritis, glenoid bone loss, and an intact rotator cuff, reaming the glenoid flat has excellent survival and clinical results at a minimum of 5 year follow up. While this technique can be successful in addressing glenoid bone loss for this indication, longer term outcomes and the limit of bone loss which can be addressed must still be investigated.

Does Medialization of Glenoid Bone-Baseplate Interface Caused By Eccentric Reaming Influence Outcomes Of Reverse Shoulder Arthroplasty?

Prashant Meshram,Stephen Weber,Jorge Rojas,Jacob Joseph,Uma Srikumaran,Edward McFarland 대한견주관절의학회 2021 대한견주관절학회 학술대회논문집 Vol.2021 No.3

Introduction and Background The purpose of this study was to evaluate the influence of different magnitudes of medialization of the bone-baseplate interface (MBBI) on clinical outcomes including range of motion (ROM), patient reported outcomes (PROs) and incidence of baseplate failure and scapula notching. Material and Method We retrospectively reviewed 91 patients who underwent primary RSA after a minimum 2-year follow-up. The amount of MBBI was estimated using a 3D CT-based computer planning software (Figure 1). Patients were categorized into three groups depending on whether MBBI was less than 3 mm (Group low MBBI, N = 32), between 3 mm to 5 mm (Group moderate MBBI, N = 30), or more than 5 mm (Group high MBBI, N = 29). Range of motion (ROM), ASES score, SST score, and scapular notching were compared between groups. Results Mean MBBI was 1.5 mm (range, 0.5 - 2.5 mm) in low MBBI group, 3.5 mm (range, 3.0 - 5.0 mm) in moderate MBBI group, and 7 mm (range, 5.5 – 10.0 mm) in high MBBI group. At the last follow-up, all patients demonstrated significant improvements in the ROM and functional scores without significant differences in the mean improvement between the three groups (Table 1). There was no correlation between the amount of MBBI and improvement in ROM in any plane. There was no statistical difference (P > 0.05) in the incidence of baseplate failure and scapula notching at the final follow up in low MBBI (17%), moderate MBBI (33%), and high MBBI group (24%). Conclusions This study found that, in primary RSA using a lateralized implant, medialization of glenoid bone-baseplate interface after eccentric reaming does not influence shoulder ROM, PROs, baseplate loosening, or glenoid notching. Further studies with more accurate measuring techniques of MBBI and its results upon patient, implant, and surgical variables are warranted.

Can Metal Artifact Reduction Sequence Magnetic Resonance Imaging (MARS-MRI) Help in the Diagnosis of Periprosthetic Shoulder Infection? A Prospective Blinded Trial

Prashant Meshram,Stephen Weber,Edward McFarland,Jacob Joseph,Benjamin Fritz,Uma Srikumaran,Jan Fritz 대한견주관절의학회 2021 대한견주관절학회 학술대회논문집 Vol.2021 No.3

Introduction and Background The utility of Metal Artifact Reduction Sequence Magnetic Resonance Imaging (MARS-MRI) in diagnosing periprosthetic shoulder infection (PSI) is unknown. The aims of the study were to 1) report the accuracy of MARS-MRI findings in diagnosing PSI, and 2) report the inter- and intra-observer reliability of MARS-MRI findings in diagnosing PSI. Material and Method Patients suspected to have PSI were prospectively recruited from one institution between 2015 and 2019. The inclusion criteria were the availability of ESR, CRP, synovial fluid aspiration, MARS-MRI, and a minimum of one year follow up (Table 1). Of 130 patients who underwent MARS-MRI, 89 (68%) patients met criteria. Patients in `the “not infected” group (total N=67) did not require a surgery at last follow up (47/67, 70%). or were categorized using the ICM 2018 classification as “unlikely” PSI (N=20/67, 30%). Patients were in the “infected” group (N) if they had a surgery after MARS MRI and per ICM 2018 criteria were “definite” PSI (N= 7, 32%), “probable” PSI (N=7, 32%), or “possible” PSI (N=8, 36%). For each MRI there were 8 findings consistent with infection, and all scans were studied independently by two blinded musculoskeletal radiologists. The diagnostic accuracy of MARS-MRI findings for PSI was evaluated with sensitivity (Sn), specificity (Sp), and accuracy (using area under the curve, AUC). Results Results The highest accuracy for diagnosis of PSI was seen with axillary lymphadenopathy (Sn=95%, Sp=92%, AUC=94%), complex joint effusion (Sn=86%, Sp=86%, AUC=86%), and edematous synovitis (Sn=91%, Sp=97%, AUC=94%) (Table 2). The intra- and inter-reader reliability of MARS-MRI findings was very good (κ > 0.8) for all studied MRI findings. Conclusions This prospective blinded study demonstrates a high accuracy and reliability of MARS-MRI for the diagnosis of PSI. Advanced MARS-MRI can be a very useful preoperative investigation for evaluating patients with painful arthroplasty for infection.

Shoulder Arthritis with Bone Loss: Is Reverse Total Shoulder Arthroplasty without Bone Grafting Successful?

Yoon S. Hyun(현윤석),Gazi Huri,Steve A. Peterson,Uma Srikumaran,Edward G. McFarland 대한견주관절의학회 2014 대한견주관절학회 학술대회논문집 Vol.2014 No.3

Racial Disparity in Time to Surgery and Complications for Hip Fracture Patients

Suresh K. Nayar,Majd Marrache,Iman Ali,Jarred Bressner,Micheal Raad,Babar Shafiq,Uma Srikumaran 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.4

Background: Racial and ethnic disparities in orthopedic surgery may be associated with worse perioperative complications. For patients with hip fractures, studies have shown that early surgery, typically within 24 to 48 hours of admission, may decrease postoperative morbidity and mortality. Our objective was to determine whether race is associated with longer time to surgery from hospital presentation and increased postoperative complications. Methods: We queried the National Surgical Quality Improvement Program database from 2011 to 2017 for patients (> 65 years) with hip fractures who underwent surgical fixation. Patients were identified using Current Procedural Terminology codes (27235, 27236, 27244, and 27245). Delayed surgery was defined as time to surgery from hospital admission that was greater than 48 hours. Time to surgery was compared between races using analysis of variance. A multivariate logistic regression analysis adjusting for comorbidities, age, sex, and surgery was performed to determine the likelihood of delayed surgery and rate of postoperative complications. Results: A total of 58,456 patients who underwent surgery for a hip fracture were included in this study. Seventy-two percent were female patients and the median age was 87 years. The median time to surgery across all patients was 24 hours. African Americans had the longest time to surgery (30.4 ± 27.6 hours) compared to Asians (26.5 ± 24.6 hours), whites (25.8 ± 23.4 hours), and other races (22.7 ± 22.0 hours) (p < 0.001). After adjusting for comorbidities, age, sex, and surgery, there was a 43% increase in the odds of delayed surgery among American Africans compared to whites (odds ratio, 1.43; 95% confidence interval, 1.29–1.58; p < 0.001). Despite higher odds of reintubation, pulmonary embolism, renal insufficiency or failure, and cardiac arrest in African Americans, mortality was significantly lower compared to white patients (4.41% vs. 6.02%, p < 0.001). Asian Americans had the lowest mortality rate (3.84%). Conclusions: A significant disparity in time to surgery and perioperative complications was seen amongst different races with only African Americans having a longer time to surgery than whites. Further study is needed to determine the etiology of this disparity and highlights the need for targeted strategies to help at-risk patient populations.