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Background: Proximal humerus fractures (PHF) are common with approximately 30% requiring surgical intervention. This ranges from open reduction internal fixation (ORIF) to shoulder arthroplasty (including hemiarthroplasty, total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA)). The aim of this study was to assess trends in operative interventions for PHF in an Australian population. Methods: Data was retrospectively collected for private patients with a PHF and requiring surgical intervention (2001–2020). Data for patients undergoing ORIF were extracted from the Medicare database, while those receiving arthroplasty for PHF were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Results: Across the study period, ORIF was the most common surgical procedure for management of PHFs. While the number of RTSA procedures for PHF has increased, shoulder hemiarthroplasty has significantly reduced since 2008 (p < 0.001). Patients aged < 65 years were more likely to receive ORIF. Patients aged ≥ 65 years were more likely to receive RTSA or hemiarthroplasty compared to patients aged < 65 years. Conclusions: While the number of ORIF procedures has increased during the period of interest, it has diminished slightly as a proportion of overall procedure volume. RTSA is becoming increasingly popular, with decreasing utilization of hemiarthroplasty, and TSA for fracture remaining uncommon. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

The aim of the present study was to individuate and compare specific machine learning algorithms that could predict postoperative anterior elevation score after reverse shoulder arthroplasty surgery at different time points. Data from 105 patients who underwent reverse shoulder arthroplasty at the same institute have been collected with the purpose of generating algorithms which could predict the target. Twenty-eight features were extracted and applied to two different machine learning techniques: Linear regression and support vector regression (SVR). These two techniques were also compared in order to define to most faithfully predictive. Using the extracted features, the SVR algorithm resulted in a mean absolute error (MAE) of 11.6° and a classification accuracy (PCC) of 0.88 on the test-set. Linear regression, instead, resulted in a MAE of 13.0° and a PCC of 0.85 on the test-set. Our machine learning study demonstrates that machine learning could provide high predictive algorithms for anterior elevation after reverse shoulder arthroplasty. The differential analysis between the utilized techniques showed higher accuracy in prediction for the support vector regression. Level of Evidence III: Retrospective cohort comparison; Computer Modeling. [ABSTRACT FROM AUTHOR]

Purpose: Clinical decision support tools (CDSTs) are software that generate patient-specific assessments that can be used to better inform healthcare provider decision making. Machine learning (ML)-based CDSTs have recently been developed for anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty to facilitate more data-driven, evidence-based decision making. Using this shoulder CDST as an example, this external validation study provides an overview of how ML-based algorithms are developed and discusses the limitations of these tools. Methods: An external validation for a novel CDST was conducted on 243 patients (120F/123M) who received a personalized prediction prior to surgery and had short-term clinical follow-up from 3 months to 2 years after primary aTSA (n = 43) or rTSA (n = 200). The outcome score and active range of motion predictions were compared to each patient's actual result at each timepoint, with the accuracy quantified by the mean absolute error (MAE). Results: The results of this external validation demonstrate the CDST accuracy to be similar (within 10%) or better than the MAEs from the published internal validation. A few predictive models were observed to have substantially lower MAEs than the internal validation, specifically, Constant (31.6% better), active abduction (22.5% better), global shoulder function (20.0% better), active external rotation (19.0% better), and active forward elevation (16.2% better), which is encouraging; however, the sample size was small. Conclusion: A greater understanding of the limitations of ML-based CDSTs will facilitate more responsible use and build trust and confidence, potentially leading to greater adoption. As CDSTs evolve, we anticipate greater shared decision making between the patient and surgeon with the aim of achieving even better outcomes and greater levels of patient satisfaction. [ABSTRACT FROM AUTHOR]

Introduction: Reverse total shoulder arthroplasty (RTSA) is a well-establish procedure with increasing incidence. Depending on the medical history, many patients undergo multiple soft-tissue procedures before RTSA. The role of acromioclavicular pathology as well as the consequences of a distal clavicle resection (DCR) before RTSA has not been evaluated yet. Material and methods: A retrospective single-center review was performed on all patients undergoing primary RTSA with or without DCR with a minimum follow-up of 2 years. We compared patient-reported outcome measures (Constant score (CS), subjective shoulder values (SSV), and range of motion (ROM)) with a matched control group. The control group consisted of patients treated with a RTSA without DCR and matching was performed for age, sex, operating side, American Society of Anesthesiologists (ASA), body mass index (BMI), and indication. Surgical time and complication rate were recorded. Results: Thirty-nine patients with a mean follow-up of 63 months (SD 33) were enrolled in the study group. Mean age was 67 years (SD 7) with 44% male patients for both groups. The mean relative CS improved from 43% (SD 17) to 73% (SD 20) in the study group, and from 43% (18) to 73% (22) in the control group. The SSV improved from 29% (SD 17) to 63% (SD 29) in the study group, and from 28% (SD 16) to 69% (SD 26) in the control group (both n.s.). The postoperative ROM did not significantly differ between the two groups. Five patients in the study group and six in the control group had reoperations. Conclusion: Patients who received a DCR before RTSA showed equivalent clinical outcomes compared to a match-control group with RTSA only. Surgical time was not different, and no complication related to the open DCR was observed in the study group. Therefore, we conclude that a prior DCR does not influence the postoperative outcome after RTSA. Level of evidence: Level III: Retrospective comparative study. [ABSTRACT FROM AUTHOR]

Purpose: There is a common belief among some shoulder surgeons that the increased utilization of reverse shoulder arthroplasty (RSA) is driven by the operation being performed in younger patients. The primary purpose of this study was to evaluate the change in patient age at the time of primary RSA in the USA. Methods: All patients undergoing primary RSA (January 2011–June 2018) were identified in the Mariner database. The mean age at the time of primary RSA was evaluated for each patient and assessed in 6-month intervals. A longitudinal comparison over time was performed for all patients. Results: A total of 56,141 primary RSA were evaluated, with the mean age increasing from 69 in the 2011 to 71 in 2018 (p < 0.001). The largest increase in RSA utilization occurred in patients > 70 (1092 in 2011 to 3499 in 2018), with patients < 50 years demonstrating the slowest growth (13 in 2011 to 65 in 2018). However, when evaluated by percentage increase from 2011 to 2018, RSA volumes for patients < 60 have increased 390% compared to 220% for those > 70 years (p < 0.001). Conclusion: RSA continues to be performed at a similar mean age despite expanded indications and surgeon comfort. However, patients < 60 years have had a greater increase in utilization compared to patients > 70 years. The volumetric growth of RSA has largely been driven by the older population, but younger patients have shown a higher percentage of growth, which may explain the generalized observation that RSA is performed in younger patients. Level of Evidence: Level III; Retrospective comparative study; Treatment study. [ABSTRACT FROM AUTHOR]

Introduction: Indications for reverse shoulder arthroplasties (rTSA) have increased since their development by Paul Grammont in 1985. Prosthesis design was enhanced over time, but the management of the tendon of the M. subscapularis (SSC-tendon) in primary rTSA is still a controversial subject with regard to perform a refixation or not. Methods: 50 patients were randomized in a refixation group (A) and a non-refixation-group (B) of the SSC-tendon in a double-blinded fashion. SSC-function was assessed at baseline before surgery, such as 3 and 12 months after surgery. Constant–Murley-Shoulder Score (CS), American Shoulder and Elbow Surgeons Score (ASES), strength, range of motion (ROM), and pain on numeric rating scale (NRS) were measured in all examinations. An ultrasound examination of the shoulder was performed for evaluation of subscapularis tendon integrity at 3 and 12 month follow-up visits. Pain was evaluated on NRS via phone 5 days after surgery. Surgery was performed by a single experienced senior surgeon in all patients. Results: Patients with a refixation of the SSC-tendon and primary rTSA had improved internal rotation [40° (20°–60°) vs. 32° (20°–45°); p = 0.03] at 12 months of follow-up. Additionally, the A-group had increased CS [74 (13–90) vs. 69.5 (40–79); p = 0.029] 1 year after surgery. Results were strengthened by subgroup analysis of successful refixation in ultrasound examination vs. no refixation. No differences were seen in ASES and NRS 1 year after rTSA. Conclusion: SSC-tendon repair in rTSA improves CS and internal rotation 12 months after surgery. [ABSTRACT FROM AUTHOR]

Purpose of Review: Reverse total shoulder arthroplasty (RTSA) is a procedure that has been increasingly utilized since its inception over 20 years ago. The purpose of this review is to present the most up to date practice and advances to the RTSA literature from the last 5 years. Recent Findings: Recent literature on RTSA has focused on identifying complications, maximizing outcomes, and determining its cost-effectiveness. RTSA has become a valuable tool in the treatment of various shoulder pathologies from fractures to massive-irreparable rotator cuff tears. Maximizing outcomes, proper patient counseling, and limiting complications are vital to a successful procedure. Summary: RTSA can be a difficult procedure; however, when utilized appropriately, it can be an invaluable tool in the orthopedic surgeon's armament. Recent evidence suggests, more and more, that RTSA not only provides value to the patient, but it is also cost-effective. [ABSTRACT FROM AUTHOR]

Background: Aim of this study was to analyze whether patients undergoing reverse shoulder arthroplasty (RSA) surgery are able to successfully return to sports and afterwards.Methods: Thirty-eight patients treated with RSA for Cuff Tear Arthropathy (CTA) were included. Two sub-groups were built: Patients who have participated in sports activities within the last 5 years prior surgery [Group A: n = 21 (55 %)] and patients who have never participated in sports [Group B: n = 17 (45 %)]. Evaluation was based on a questionnaire asking types of sports, frequency, and time to return to sports.Results: Mean age in Group A at the time of surgery was 76.2 (65-85) years and 78.4 (68-92) years in Group B. Most patients were women [n = 35 (92 %)]. Mean follow-up was 4.8 years (2.4-9.4) years. Fifteen (71 %) patients in Group A participated in sports at the time prior to surgery. Fourteen (67 %) patients returned to sports after surgery. The returning rate was 93 %. Six (29 %) patients of Group A stated that one reason they underwent shoulder replacement surgery was to continue to participate in sports. All active patients performed swimming at final follow up.Conclusions: Most patients being active prior to reverse shoulder arthroplasty surgery are successfully able to return to their activity afterwards. [ABSTRACT FROM AUTHOR]

We describe our experience with a new system of patient-specific template called Personal Fit, which is unique in shoulder surgery and used in combination with Duocentric prosthesis. The reverse prosthesis's concept is the invention of Paul Grammont, developed with Grammont's team of Dijon University as from 1981, which led to the first reversed total shoulder prosthesis called Trumpet in 1985. The Duocentric prosthesis developed in 2001 is the third-generation prosthesis, coming from the Trumpet and the second-generation prosthesis Delta (DePuy). This prosthesis provides a novel solution to the notching problem with an inferior overhang integrated onto the glenoid baseplate. Personal Fit system is based on reconstructing the shoulder joint bones in three dimensions using CT scan data, placing a landmark on the scapula and locating points on the glenoid and humerus. That will be used as a reference for the patient-specific templates. We study the glenoid position planned with Personal Fit software relative to native glenoid position in 30 cases. On average, the difference between the planned retroversion (or anteversion in one case) and native retroversion was 8.6°. [ABSTRACT FROM AUTHOR]