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Purpose: The purpose of this study was to systematically review the available level I evidence regarding the impact of tranexamic acid (TXA) on early postoperative outcomes in patients undergoing anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA). Methods: A systematic review of the literature through April 2023 was performed to identify level I RCTs examining the use of TXA at the time of primary TSA or RTSA. Results: Among 5 included studies, a total of 435 patients (219 TXA, 216 control) were identified. Superior hematologic outcomes were observed among the TXA cohort, including lower 24-hour drain output (MD −112.70 mL: p < 0.001), lower pre- to postoperative change in hemoglobin (MD: −0.68 g/dL, p < 0.001), and less total perioperative blood loss (MD: −249.56 mL, p < 0.001). Postoperative Visual Analog Scale for pain (VAS-pain) scores were lower in the TXA group, but not significantly (MD: −0.46, p = 0.17). Postoperative blood transfusion was required in 3/219 TXA patients (1.4%) and 7/216 control patients (3.2%) (RR: 0.40, p = 0.16). Conclusion: Perioperative TXA reduces drain output and total blood loss without increasing the risk of adverse events. TXA was not shown to decrease postoperative transfusion rates when compared to placebo controls. Level of Evidence: Level I, meta-analysis. [ABSTRACT FROM AUTHOR]

Background: Glenoid loosening is an issue in anatomic total shoulder arthroplasty (a-TSA). This has been attributed to abnormal glenoid anatomy, common among these patients. Different alternatives have been proposed to tackle glenoid bone loss and restore joint alignment with augmented glenoid implants being increasingly used to deal with this problem. This systematic review aims to evaluate the clinical and radiological outcomes of patients undergoing augmented glenoid a-TSAs. Our hypothesis was that augmented glenoid components will lead to good patient outcomes with a low incidence of complications and revision procedures. Methods: MEDLINE, EMBASE, CENTRAL and CINHAL were searched from inception to February 2022 for information pertaining to outcomes of patients undergoing a-TSA with augmented glenoid implants. Results: Eighteen studies reported on outcomes of 814 a-TSA (800 participants) with a mean follow-up of 3.7 years. Most studies (67%) were Type IV level of evidence. Almost 70% of participants underwent an a-TSA secondary to primary glenohumeral osteoarthritis. Most glenoids were type B2 (73%). Augmented glenoids material was mostly all-polyethylene (81%) with full wedge (45%) and stepped components (38%) designs being the most common. Most studies reported good clinical outcomes. 17 patients (4%) underwent a revision surgery. Conclusions: Our review found that patients undergoing a-TSA with augmented glenoid components report good outcomes at short-to-mid-term follow-up. Further research is warranted to determine if such outcomes remain similar in long term. Level of evidence: Level III, Systematic Review of Therapeutic Studies. [ABSTRACT FROM AUTHOR]

Background: The objective was to evaluate the short-term clinical and radiological outcomes following augmented anatomic total shoulder arthroplasty in patients with posterior glenoid deficiency. Methods: An electronic search of EMBASE, MEDLINE, and PubMed identified studies reporting clinical and radiographic outcomes following augmented anatomic total shoulder arthroplasty among patients with posterior glenoid deficiency. Results: Nine studies including 312 shoulders underwent anatomic total shoulder arthroplasty using an augmented glenoid implant between 2015 and 2020. A statistically significant improvement in range of motion (ROM), visual analog scale (VAS), American Shoulder & Elbow Surgeons (ASES), Constant, University of California - Los Angeles and Simple Shoulder Test (SST) scores was demonstrated at mean follow-up of 37.1 months. Glenoid retroversion improved from 21.8° to 9.5°. At final follow-up, radiolucency was reported in 35.1% of shoulders. The 16° full-wedge augment led to higher and more severe radiographic lucency, while high peg perforation rates (44%) were observed among 5-mm augment stepped implants. The overall rate of complication was 2.6%. Rate of revision surgery was 1.9%. Conclusions: Overall, early- to mid-term outcomes following augmented anatomic total shoulder arthroplasty for posterior glenoid deficiency demonstrate good to excellent overall clinical results. More radiographic and clinical failures were reported in larger full wedge (16°) augments and stepped augments (5 mm). Prospective studies examining mid- and long-term outcomes will help further elucidate safety and efficacy of these relatively new implants. [ABSTRACT FROM AUTHOR]

Background: US Food and Drug Administration Investigation Device Exemption studies and academic journals emphasize the importance of two-year follow-up data in reporting outcomes of total shoulder arthroplasty, but there is limited data evaluating appropriate follow-up length. We aim to evaluate change in postoperative outcomes and complications between one and two years following anatomic and reverse total shoulder arthroplasties. Methods: We retrospectively identified 250 patients who underwent anatomic and reverse total shoulder arthroplasties between 2013 and 2016 from a single surgeon arthroplasty registry. Patients without both one- and two-year follow-up data were excluded. We compared American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Scale for pain, and goniometer-measured range of motion. Results: Patient-reported outcome measurements (p > 0.05) did not change between one and two years postoperatively following both reverse (n = 146) and anatomic (n = 104) total shoulder arthroplasties. Range of motion increased slightly (p < 0.05), but this change was not clinically relevant. There were no additional complications. Discussion: Minimum two-year clinical follow-up may not be necessary for future shoulder arthroplasty Investigation Device Exemption and other peer-reviewed investigations. Patient-reported outcomes (ASES and pain score) and range of motion plateau at one year postoperatively without additional complications. One-year follow-up is an acceptable minimum follow-up length. Level of evidence: Level III—retrospective analysis. [ABSTRACT FROM AUTHOR]