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Purpose: Scapular Notching (SN) is one of the most common postoperative complications for a patient after Reverse Total Shoulder Arthroplasty (RTSA). Despite employing various strategies to mitigate SN risk, the overall incidence remains far from zero. This article introduces a new risk factor, the scapulo-humeral angle (SHA), as a key element influencing the risk for SN. Methods: A retrospective analysis was conducted on all patients who underwent RTSA for rotator cuff arthropathy at the study centre. The preoperative SHA was measured, and the presence of SN was investigated and graded using the Nerot classification at the latest follow-up. Results: 42 patients were included. 12 presented SN (incidence 28.5%). A statistically significant Pearson coefficient correlation between pre-operative SHA and the incidence of SN was observed (r= -0.6954; 95% C.I. -0,8250 to -0,4963; p < 0.0001). A statistically significant Pearson coefficient correlation was also found between the degree of SN and the pre-operative SHA (r= -0,7045; 95% C.I. -0,8306 to -0,5096; P value (two-tailed) < 0,0001, alpha 0.05). Conclusions: The primary finding is a statistically significant correlation between a reduced preoperative SHA and an increased incidence of postoperative SN. The secondary finding is that a smaller preoperative SHA is associated with a more severe degree of SN A SHA cut-off of 50° distinguished patients at high risk of SN from those at low risk. All patients with an SHA below 50° developed SN (10/10), whereas only 6.25% of patients with an SHA exceeding 50° experienced SN (2/32). [ABSTRACT FROM AUTHOR]

Anatomic and reverse total shoulder arthroplasty (TSA) are effective treatment options for end-stage glenohumeral osteoarthritis. However, consideration for pre-existing conditions must be taken into account. Factor V Leiden (FVL), the most common inherited thrombophilia, is one such condition that predisposes to a prothrombotic state and may affect perioperative and longer-term outcomes following TSA. Adult patients undergoing primary TSA for osteoarthritis indication were identified in the 2010 through October 2021 PearlDiver M157 database. Patients with or without FVL were matched at a 1:4 ratio based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events and 5-year revision rates were assessed and compared with multivariable logistic regression and rank-log tests, respectively. Finally, the relative use and bleeding/clotting outcomes were assessed based on venous thromboembolic (VTE) prophylactic agents used, with categories defined as (1) warfarin, heparin, or direct oral anticoagulant (DOAC) or (2) aspirin/no prescription found. Of 104,258 TSA patients, FVL was identified for 283 (0.27%). Based on matching, 1081 patients without FVL and 272 patients with FVL were selected. Multivariable analyses demonstrated that those with FVL displayed independently greater odds ratios (ORs) of deep vein thrombosis (DVT, OR = 9.50, P <.0001), pulmonary embolism (PE, OR = 10.10, P <.0001), and pneumonia (OR = 2.43, P =.0019). Further, these events contributed to the increased odds of aggregated minor (OR = 1.95, P =.0001), serious (OR = 6.38, P <.0001), and all (OR = 3.51, P <.0001) adverse events. All other individual 90-day adverse events, as well as 5-year revision rates, were not different between the study groups. When compared to matched patients without FVL on the same anticoagulant agents, FVL patients on warfarin, heparin, or DOAC agents demonstrated lesser odds of 90-day DVT and PE (OR = 4.25, P <.0001, and OR = 2.54, P =.0065) than those on aspirin/no prescription found (OR = 7.64 and OR = 21.95, P <.0001 for both). Interestingly, those on VTE prophylactic agents were not at greater odds of bleeding complications (hematoma or transfusion). TSA patients with FVL present a difficult challenge to shoulder reconstruction surgeons. The current study highlights the strong risk of VTE that was reduced but still significantly elevated for those with stronger classes of VTE chemoprophylaxis. Acknowledging this risk is important for surgical planning and patient counseling, but also noted was the reassurance of similar 5-year revision rates for those with vs. without FVL. [ABSTRACT FROM AUTHOR]

Objectives Proximal humeral fractures (PHFs) show a high incidence in aged patients. While nondisplaced fractures achieve good results by conservative treatment, surgical procedures are discussed controversially. Next to open reduction and internal fixation (ORIF), the primary use of reverse shoulder arthroplasty (RSA) has become increasingly important. The aim of this study was to investigate the clinical function, activities of daily living (ADL), as well as pain assessment in patients with PHFs, treated by ORIF or RSA. Methods A retrospective comparison study was assessed. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF or RSA of the proximal humerus, were included in this study. Pain was measured by numeric rating scale (NRS). ADL were obtained by Katz‐Index and SF‐12. Moreover, shoulder function was assessed using the Oxford Shoulder Score (OSS). The maximum range of motion (ROM) was also recorded. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF (Figure or RSA of the proximal humerus) were included in this study. For statistical analyses, Student's t‐test, Wilcoxon test, and Chi‐Quadrat test were used. Statistical significance was indicated with p

Background: Radiographs are frequently obtained after total shoulder arthroplasty (TSA) to confirm implant placement and follow the status of the bone and prostheses; however, standardization of their use is lacking. There are concerns regarding frequent use of radiographs due to their cost and patient radiation exposure. The aim of this study is to assess the postoperative radiograph frequency and efficacy in primary anatomic and reverse total shoulder arthroplasty. We hypothesize that multiple radiographs taken beyond the initial 2-week postoperative interval are of uncertain benefit for both primary anatomic and reverse total shoulder arthroplasties, regardless of the presence of symptoms., Methods: A retrospective chart and imaging review was conducted on all patients who underwent primary TSA between 2014 and 2021, with documentation of at least 2 years of follow-up. All available postoperative radiographs, radiologist interpretations, and clinic notes were followed up for 2 years after the date of surgery, or until another surgery was performed within the 2-year timeframe. Radiographs were assessed for component positioning, fractures, loosening, and dislocation. Clinic notes were also checked for changes in patient management. Patients were grouped by surgery type (anatomic/reverse)., Results: A total of 213 patients (234 surgeries) were identified (55 anatomic TSA, 179 reverse TSA). The mean number of radiographs within the first 2 years of surgery was 3.6 for anatomic TSA and 4.0 for reverse TSA. 166 patients were asymptomatic and had only 3 positive X-rays and zero revision rate in the first 2 years. No changes in management were implemented based on these routine radiographs. 68 surgeries were symptomatic, of which 21 had positive X-rays. Of this subgroup, 19 (90.5%) underwent revision., Conclusion: Routine radiographs are overused and typically do not lead to any changes in asymptomatic patients in the first 2 years after TSA. For patients experiencing pain or limited range of motion, ongoing assessment using additional X-rays, CT scans, or other diagnostic tests is recommended for effective monitoring., (Copyright © 2025. Published by Elsevier Inc.)