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Reverse total shoulder arthroplasty (rTSA) in the presence of significant glenoid bone loss remains a challenge. This study presents preliminary clinical and radiographic outcomes of primary and revision rTSA using a patient-matched, 3-dimensionally printed custom metal glenoid implant to address severe glenoid bone deficiency.Between September 2017 and November 2018, 19 patients with severe glenoid bone deficiency underwent primary (n = 9) or revision rTSA (n = 10) using the Comprehensive Vault Reconstruction System (VRS) (Zimmer Biomet, Warsaw, IN, USA) at a single institution. Preoperative and postoperative values for the Disabilities of the Arm, Shoulder and Hand score, Constant score, American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, Single Assessment Numeric Evaluation score, and visual analog scale pain score and active range of motion were compared using the Wilcoxon signed rank test with the level of statistical significance set at P.05.Complications occurred in 4 patients (21%), including a nondisplaced greater tuberosity fracture treated conservatively in 1, intraoperative cortical perforation during humeral cement removal treated with an allograft strut in 1, and recurrent instability and hematoma formation treated with humeral component revision in 1. One patient with an early periprosthetic infection was treated with component removal and antibiotic spacer placement at an outside facility and was subsequently lost to follow-up. Eighteen patients with 1-year minimum clinical and radiographic follow-up were evaluated (mean, 18.2 months; range, 12-27 months). Significant improvements were noted in the mean Disabilities of the Arm, Shoulder and Hand score (57.4 ± 16.5 vs. 29.4 ± 19.5, P.001), mean Constant score (24.6 ± 10.2 vs. 60.4 ± 14.5, P.001), mean American Shoulder and Elbow Surgeons score (32 ± 18.2 vs. 79 ± 15.6, P.001), mean Simple Shoulder Test score (4.5 ± 2.6 vs. 9.3 ± 1.8, P.001), mean Single Assessment Numeric Evaluation score (25.4 ± 13.7 vs. 72.2 ± 17.8, P.001), mean visual analog scale pain score (6.2 ± 2.9 vs. 0.7 ± 1.3, P.001), mean active forward flexion (53° ± 27° vs. 124° ± 23°, P.001), and mean active abduction (42° ± 17° to 77° ± 15°, P.001). Mean external rotation changed from 17° ± 19° to 32° ± 24° (P = .06). No radiographic evidence of component loosening, scapular notching, or hardware failure was observed at last follow-up in any patient.The preliminary results of rTSA using the VRS to manage severe glenoid bone deficiency are promising, but longer follow-up is necessary to determine the longevity of this implant.

Background Magnetic resonance imaging (MRI) findings in asymptomatic patients have been described for hips, knees, ankles, shoulders, and intervertebral disks. No such description exists for the elbow. Methods MRI scans of 189 asymptomatic elbows divided into 3 groups by age (group 1, 20-39 years; group 2, 40-59 years; and group 3, ≥60 years) were evaluated for abnormalities within 13 anatomic structures using a novel classification system. Results At least 1 variation was found in all elbows. Of the 13 structures, 8 showed an increase in the prevalence and intensity of signal changes with aging, 2 remained the same, and 2 showed a decrease. One anatomic structure showed no variations in any elbow. Conclusions Elbow MRI variations may be seen regardless of symptoms. These changes appear to increase in prevalence and intensity with age. Results from this study can be used to help guide the clinician in interpreting MRI findings of the elbow. We hope this study helps provide a contextual background for discussing MRI findings with patients and differentiating age-related variations from true pathology.

Objectives: Treatment options for recurrent shoulder instability, in the setting of significant glenoid bone loss, consists of several iterations of bone stabilization procedures. However, advanced arthritic changes with the Laterjet procedure and rapid resorption changes with the iliac crest bone graft reconstruction has led into the search for more optimal surgical reconstruction options. The purpose of this study is to evaluate the clinical and functional outcomes of patients with recurrent shoulder instability, with significant glenoid bone loss, treated with fresh distal tibial allograft reconstruction with regards to recurrence, revision surgery, and complications. Methods: At a single institution, all consecutive patients with recurrent shoulder instability and at least 15% anterior glenoid bone loss, undergoing distal tibial allograft reconstruction, between 2011 to 2016, were identified by diagnostic and procedural codes. All clinical notes, diagnostic imaging, and operative reports were reviewed in detail. From these sources, demographics, operative techniques, and radiographic parameters were collected and measured. Functional outcome scores were prospectively collected from patients. The primary outcome of the study was the Disability of Arm, Shoulder, Hand (DASH) score. The secondary outcomes of the study were the Visual Analog Scale (VAS) pain score, Single Assessment Numeric Evaluation (SANE) score, recurrent instability, revision surgery, and complications. Results: At 6 years, there were a total of 36 distal tibial allograft reconstructions performed in patients with recurrent shoulder instability in the setting of significant glenoid bone loss. Amongst this cohort, average age was 35 years old with 72% of patients being male. The dominant extremity was involved in 20 (56%) of patients and 24 (67%) of patients had previous surgery to address episodes of shoulder instability. Follow-up, for the entire cohort was on average 15.5 months. In comparison to preoperative range of motion, after surgery there was significantly less abduction (P=0.01). At final follow-up, patients undergoing distial tibial allograft reconstruction showed trend towards significant improvement in the DASH score (preoperative DASH=50.7, postoperative DASH=37.1, P=0.09). In like manner, there was significant improvement in both the VAS score (P=0.001) and the SANE score (P=0.002). There was no significant difference in functional outcome scores between those patients who had failed a previous surgery for instability. Recurrent instability, after distal tibial allograft reconstruction, occurred in 4 (11%) of patients and 8 (22%) of patients underwent an additional surgical procedure. Complications occurred in 31% of patients, with the most common complication being rupture of the subscapularis. Conclusion: This study provides functional outcomes in one of the largest consecutive cohort of patients undergoing distal tibial allograft reconstruction for recurrent shoulder instability due to significant glenoid bone loss. The study suggests that distal tibial allograft reconstruction may provide improved functional outcomes in patients with recurrent shoulder instability. After this procedure, 89% of patients did not experience any additional episodes of shoulder instability. Despite these encouraging results, complications are common after this procedure, with 31% of patients experiencing a complication. Table 2. Range of Motion & Physical Examination in patients with Tibial Plafond Allograft Reconstruction Tibial Plafond Allograft (n = 36) Preoperative Postoperative P-Value Range of Motion (Active) Abduction 102.2 ± 26.8 82.6 ± 14.8 0.01 Forward Flexion 125.8 ± 31.3 137.9 ± 32.9 0.25 External Rotation 46.1 ± 9.8 43.2 ± 10.1 0.52 Internal Rotation 47.8 ± 9.3 52.3 ± 12.5 0.46 Continuous data are reported as mean ± standard deviation. Categorical data reported as number (%). Table 3. Functional Outcomes at Final Follow-Up of Tibial Platfond Allograft Reconstruction Tibial Plafond Allograft (n = 36) Preoperative Postoperative P-Value Primary Outcome DASH 50.7 ± 27.8 37.1 ± 27.4 0.09 Secondary Outcome Vas 5.62 ± 2.7 43.2 ± 10.1 0.001 SANE 32.5 ± 18.9 75.8 ± 21.9 0.002 Continuous data are reported as mean ± standard deviation.

An accurate preoperative measurement of glenoid orientation is crucial for evaluating pathologies and successful total shoulder arthroplasty. Existing methods may be labor-intensive, observer-dependent, and sensitive to the misalignment between the scapula plane and CT scanning direction. In this study, we proposed a computation framework and performed an automated analysis of the glenoid orientation based on 3D surface data. Three-dimensional models of 12 scapulae were analyzed. The glenoid cavity and external anatomical features were automatically extracted from these 3D models. Glenoid version was calculated using the scapula plane and the fulcrum axis alternatively. Glenoid inclination was measured both relative to transverse axis of the scapula and the medial pole-inferior tip axis. The mean (±SD) of the fulcrum-based glenoid version was -0.55° (±4.17°), while the scapular-plane-based glenoid version was -5.05° (±3.50°). The mean (±SD) of glenoid inclinations based on the medial pole and inferior tip was 12.75° (±5.03°) while the mean (±SD) of the glenoid inclination based on the medial pole and glenoid center was 4.63° (±4.86°). Our computational framework was able to extract the reproducible morphological measures free of inter- and intra- observer variability. For the first time in 3D, we showed that the fulcrum axis was practically perpendicular to the glenoid plane normal (radial line), and thus extended the fulcrum-based glenoid version for quantifying 3D glenoid orientation. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:692-698, 2016.

Background The Hirsch index (h-index), widely considered a valuable measure of assessing academic productivity, has been studied in various medical and surgical specialties and has shown strong associations between higher h-indices and academic promotion, as well as with National Institutes of Health (NIH) awards. Additionally, the m-index and e-index may complement the h-index in this assessment of merit. The purpose of this study was to investigate the relationship between the h, m, and e-indices and academic rank for 2,061 academic orthopaedic surgeons in the United States. Methods The h-indices of faculty members from 120 academic orthopaedic surgery residency programs were organized and calculated using the Scopus and Google Scholar databases. Additionally, m-index and e-index scores were calculated from Google Scholar. After application of exclusion criteria, 2,061 academic orthopaedic surgeons were included. Results Academic rank (assistant professor, associate professor, professor, and chair) increases as mean h-index, m-index, and e-index scores increase. Among 976 assistant professors, 504 associate professors, 461 professors, and 120 chairs, mean h, m, and e-indices increased with each academic rank. In the comparison of male and female surgeons, there was no significant difference in h, m, or e-index scores, with the exception of increased h-index scores among male assistant professors. Conclusions Scholarly impact, as defined by academic productivity and scientific relevance, can be classified by the h-index and supplemented by the m and e-indices. This study has revealed well-defined differences in h, m, and e-indices with regard to academic rank among orthopaedic surgeons. Although the h, m, and e-indices may be of value as adjunct assessment devices for scholarly merit, careful consideration of their limitations must be maintained.