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Recent literature has yet to compare perioperative metrics of total shoulder arthroplasty (TSA) vs. total hip (THA) and knee (TKA) arthroplasty. The National Surgical Quality Improvement Program database was utilized to investigate perioperative metrics for patients undergoing primary TSA, THA, or TKA from 2012 to 2020. Adjusted and unadjusted analyses were employed to compare patient characteristics, operative times, lengths of stay, readmissions, adverse events, and annual surgical volumes between cohorts. Of 748,153 included patients; 32,222 (4.31%); 279,528 (37.36%); and 436,403 (58.33%) underwent TSA, THA, and TKA, respectively. TSA operative times ([mean ± SD]: 109.21 ± 44.62 minutes) were longer than those for THA (91.28 ± 38.48 minutes) and TKA (90.02 ± 34.85 minutes). Conversely, TSA patients experienced shorter hospital stays (1.61 ± 2.26 days; P <.001) relative to those receiving hip (2.26 ± 2.77 days) or knee (2.33 ± 2.30 days) arthroplasty. Logistic regression models controlling for demographics and comorbidities revealed patients undergoing TSA were less likely to be readmitted (adjusted relative risk [ARR] 0.78, 95% confidence interval [CI] 0.73-0.83) or sustain serious (ARR 0.84, 95% CI: 0.78-0.90) or minor (ARR 0.58, 95% CI: 0.51-0.65) adverse events than those receiving THA or TKA (P <.001 for all). Finally, when comparing arthroplasty utilization rates from 2012 to 2020, the proportion of TSA increased significantly (from 3.16% to 5.08%) relative to THA (from 38.4% to 39.8%) and TKA (from 58.5% to 55.1%; P trend <.001). Although performed less frequently, TSA is associated with significantly shorter hospital stays, lower likelihoods of readmission, and fewer complications than THA and TKA. These findings corroborate the relative safety of TSA and highlight its increasing utilization in the United States. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify nationwide disparities in the rates of operative management of rotator cuff tears based on race, ethnicity, insurance type, and socioeconomic status. Patients diagnosed with a full or partial rotator cuff tear from 2006 to 2014 were identified in the Healthcare Cost and Utilization Project's National Inpatient Sample database using International Classification of Diseases, Ninth Revision diagnosis codes. Bivariate analysis using chi-square tests and adjusted, multivariable logistic regression models were used to evaluate differences in the rates of operative vs. nonoperative management for rotator cuff tears. This study included 46,167 patients. When compared with white patients, adjusted analysis showed that minority race and ethnicity were associated with lower rates of operative management for Black (adjusted odds ratio [AOR]: 0.31, 95% confidence interval [CI]: 0.29-0.33; P <.001), Hispanic (AOR: 0.49, 95% CI: 0.45-0.52; P <.001), Asian or Pacific Islander (AOR: 0.72, 95% CI: 0.61-0.84; P <.001), and Native American patients (AOR: 0.65, 95% CI: 0.50-0.86; P =.002). In comparison to privately insured patients, our analysis also found that self-payers (AOR: 0.08, 95% CI: 0.07-0.10; P <.001), Medicare beneficiaries (AOR: 0.76, 95% CI: 0.72-0.81; P <.001), and Medicaid beneficiaries (AOR: 0.33, 95% CI: 0.30-0.36; P <.001) had lower odds of receiving surgical intervention. Additionally, relative to those in the bottom income quartile, patients in all other quartiles experienced nominally higher rates of operative repair; these differences were statistically significant for the second quartile (AOR: 1.09, 95% CI: 1.03-1.16; P =.004). There are significant nationwide disparities in the likelihood of receiving operative management for rotator cuff tear patients of differing race/ethnicity, payer status, and socioeconomic status. Further investigation is needed to fully understand and address causes of these discrepancies to optimize care pathways. [ABSTRACT FROM AUTHOR]

We describe a combined all-inside, inside-out, and outside-in technique for the repair of unstable bucket-handle medial meniscal tears. Notably, a greater incidence of neurovascular complications has been associated with meniscal repair techniques that employ an accessory skin incision, especially when damage involves the body of the medial meniscus. However, with the operative knee in relative extension, passing inside-out needles anteromedial to the posterior horn and posterior to the semitendinosus tendon and saphenous nerve allows for the needles to exit the posteromedial knee through a "safe zone." Therefore, we reduce iatrogenic damage by avoiding the necessity of a large safety incision while still maintaining suture placement versatility and meniscal fragment stabilization. Thus, the objective of this Technical Note is to outline an efficient technique for treating bucket-handle medial meniscal tears that yields a strong, durable repair while avoiding damage to adjacent neurovascular structures and eliminating the need for a posteromedial safety incision. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Female gender and surgical drain use have been associated with an increased transfusion risk following single-anesthetic bilateral total knee arthroplasty (SBTKA). This study evaluated allogenic blood transfusion rates among female and male patients undergoing SBTKA with intraoperative tourniquet, tranexamic acid and contemporary blood transfusion thresholds but without surgical drain use.Methods: We performed a retrospective electronic medical record review for 125 consecutive patients undergoing SBTKA (250 knees) between May 1, 2015 and July 10, 2021. Patient demographic characteristics (age, gender, body mass index, American Society of Anesthesiologists), preoperative and postoperative hemoglobin levels, perioperative transfusions, operative time, and hospital length of stay were compared between 76 female (60.8%) and 49 male (39.2%) patient cohorts using paired Student's t-test or Fisher's exact test with a P value <.05 for significance.Results: No patient in either gender-based cohort received a perioperative allogeneic or autologous blood transfusion (P = 1). There were no significant differences in patient demographic features or medical comorbidities. Male patients had significantly higher mean preoperative (14.7 versus 13.7 g/dL, P < .01) and postoperative (12.7 versus 11.8 g/dL, P < .01) hemoglobin levels and a shorter mean hospital length of stay (2.5 versus 3.0 days, P < .01). There was no difference in the mean operative time (154.7 versus 150.7 minutes, P = .34) or change in the hemoglobin level (2.1 versus 1.9 g/dL, P = .27).Conclusion: SBTKA can be performed with a limited risk of perioperative transfusion with a combination of intraoperative tourniquet, tranexamic acid, conservative blood transfusion criteria, and avoidance of postoperative drain use. Study results were not influenced by patient gender.Level Of Evidence: This is a level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Background: Non-optimal patellofemoral relationships may influence treatment decisions during revision total knee arthroplasty (TKA). We performed this study to determine whether patellar implant malposition or patellar tilt is associated with inferior patient-reported outcome scores or patient satisfaction after primary TKA.Methods: We identified 396 TKA patients (439 knees) from an institutional registry who had undergone patellar resurfacing, with preoperative and 6-week postoperative radiographs available, and patient-reported outcome measures (PROMs) completed at least 1 year after surgery (mean 505 days). Preoperative patient demographic characteristics, patient-reported expectations, National Institutes of Health - Patient Reported Outcomes Measurements Instrument Systems global health, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and University of California Los Angeles activity scores were compared between 60 TKAs performed with non-optimal patellofemoral relationships (36 patellar implant malposition, 24 patellar tilt) and 379 TKAs performed with optimal patellar implant placement.Results: There were no differences between the 2 cohorts regarding demographic features, preoperative radiographic disease severity, expectations, and PROMs; or postoperative tibiofemoral component alignment, PROMs, and patient-reported satisfaction (P = .48). Knee Injury and Osteoarthritis Outcome Score for Joint Replacement improved similarly (P = .62) for patients with optimal resurfacing (48.5-77.6 points) and non-optimal resurfacing (47.7-76.6 points). A similar proportion of optimal and suboptimal resurfaced patients reported being satisfied with their TKA (92.7% vs 88.1%, P = .29).Conclusion: Although suboptimal patellofemoral relationships may prompt treatment considerations during revision TKA, the data obtained from this study do not suggest that patellar implant malposition or patellar tilt independently contribute to postoperative pain, functional limitation, or dissatisfaction.Level Of Evidence: This is a level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

To investigate whether paralabral cysts identified incidentally on preoperative magnetic resonance imaging/arthrography predict 2-year functional outcomes after arthroscopic acetabular labral repair. Prospectively collected data for patients undergoing primary hip arthroscopy by a single surgeon from 2014 to 2020 were retrospectively reviewed. Included patients were ≥18 years and completed baseline patient-reported outcome measures (PROMs) with additional follow-up at 3, 6, 12, and 24 months. Exclusion criteria were labral debridement, hip dysplasia, advanced hip osteoarthritis (Tönnis > 1), or previous ipsilateral hip surgery. Patients were stratified based on the presence of paralabral cysts identified on magnetic resonance imaging/arthrography. Primary outcomes were International Hip Outcome Tool and modified Harris Hip Score. Secondary outcomes included other PROMs and the visual analog pain scale. Outcomes were compared between cohorts using linear mixed-effects models and Fisher's exact tests. Sensitivity analyses accounted for preoperative PROMs, nonlinear improvement trajectories, and relevant baseline characteristics. Of the 182 included hips (47.8% female; mean ± standard deviation age, 36.9 ± 11.4), 30 (16.4%) had paralabral cysts. During the 2-year study period, there were no significant differences between patients with and without paralabral cysts in terms of International Hip Outcome Tool scores (weighted difference = 1.60; 95% confidence interval [CI], −5.09, 8.28; P =.64), modified Harris Hip Scores (weighted difference = 0.56; 95% CI, −4.16, 5.28; P =.82), or any secondary outcomes (except for HOS–Sports Subscale at 3 months [mean difference = −11.85; 95% CI, −22.85, −0.84; P =.035]). Furthermore, there were no significant differences in clinically meaningful outcomes (P >.05 for all), revision rates (P >.99), or conversion to total hip arthroplasty between cohorts (P >.99). These results held across all sensitivity analyses. Although preoperative paralabral cysts were associated with worse cam impingement and more severe chondral damage observed intraoperatively, they did not predict 2-year functional outcomes or clinically meaningful improvements, suggesting that incidentally discovered paralabral cysts are not a contraindication for arthroscopic labral repair. Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]