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ABSTRACT: BACKGROUND: It is technically difficult to obtain high-quality, postoperative shoulder radiographs immediately after surgery. Further, poor-quality radiographs may be unlikely to change clinical practice or improve patient outcomes. We therefore questioned the value of routine postoperative radiographs after shoulder arthroplasty. QUESTIONS/PURPOSES: We asked whether (1) postanesthesia care unit (PACU) radiographs can reasonably serve as a baseline for future studies; and (2) routine PACU radiographs change clinical care. (3) We also determined the charges associated with routine PACU radiographs and formal radiographic interpretation of these images. METHODS: We retrospectively compared the radiographs of 283 patients who had shoulder arthroplasties (Group 1) who underwent PACU radiographs with those of 241 patients (Group 2) who had their first postoperative radiographs at a later date. Radiographs were compared for quality, ability to serve as a baseline, and their influence on clinical course. Orthopaedic evaluation of each radiograph and the radiographic report were compared and charges were analyzed. RESULTS: All images in Group 1 were single-view radiographs (88% internal rotation), most were underpenetrated (71%); no images changed postoperative management or were considered adequate to serve as a baseline. Group 2 radiographs were multiview radiographs, and 83% were deemed adequate to serve as baseline radiographs. Radiographic interpretation of immediate postoperative radiographs did not change the clinical course or treatment. The charges billed from radiographic evaluation in this study were $64,524 for Group 1. CONCLUSIONS: Routine PACU radiographs, in the absence of a specific indication, may result in poor-quality images. Elimination of these radiographs and radiographic interpretation after shoulder arthroplasty may reduce charges without changing clinical care. LEVEL OF EVIDENCE: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 08/2012; · 2.53 Impact Factor
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ABSTRACT: Massive and irreparable posterior-superior rotator cuff tears present a difficult treatment problem. The purpose of this systematic review was to critically examine the outcomes of latissimus dorsi tendon transfers for the treatment of irreparable rotator cuff tears.
A systematic review of the literature was performed via a search of electronic databases. Two reviewers independently assessed the methodological quality of, and extracted relevant data from, each included study. In cases in which the outcomes data were similar between studies, data were pooled for the purposes of generating summary outcomes through the use of frequency-weighted values.
Ten studies that fulfilled all inclusion and exclusion criteria were included. The frequency-weighted mean age was 58.7 years. Patients were followed for a frequency-weighted mean of 45.5 months (range, twenty-four to 126 months). Patients had a frequency-weighted mean adjusted Constant score of 45.9 preoperatively compared with 73.2 postoperatively (p < 0.001). The frequency-weighted mean active forward elevation improved from 101.9° preoperatively to 137.4° postoperatively (p < 0.001), and the frequency-weighted mean active external rotation improved from 16.8° to 26.7° (p < 0.001). Subscapularis muscle insufficiency, advanced teres minor muscle atrophy, and the need for revision surgery were correlated with poor functional outcomes in some studies.
Compiled data and frequency-weighted means demonstrated improvement in shoulder function, range of motion, strength, and pain relief after latissimus dorsi tendon transfer for irreparable rotator cuff tears. Patients and physicians should not expect an outcome of "normal" function or complete pain relief.
The Journal of Bone and Joint Surgery 05/2012; 94(10):891-8. · 3.27 Impact Factor
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ABSTRACT: BACKGROUND: The number of times an article has been cited has been used as a marker of its influence in a medical specialty. The purpose of this study was to determine the 50 most cited articles in shoulder surgery and their characteristics. METHODS: Science Citation Index Expanded was searched for citations of articles published in any of the 61 journals in the category "Orthopedics." Each of the journals was searched to determine the 50 most often cited articles specific to shoulder surgery. The following characteristics were determined for each article: authors, year of publication, source journal, geographic origin, article type, and level of evidence for clinical articles. Citation density (total number of citations/years since publication) was also determined. RESULTS: The number of citations ranged from 1211 to 192. The 50 most often cited articles were published in 8 journals. The majority of the articles (42) were clinical, with the remaining representing some type of basic science research. The most common level of evidence was IV (23). The mean number of citations for methodologic articles (437 citations per article) was greater than that for non-methodologic articles (301 citations per article) (P = .034). CONCLUSIONS: Articles that introduced instruments for outcome evaluation or that introduced classification systems (methodologic) were highly cited regardless of the date of publication. The top 50 list presented provides residency and fellowship directors with a group of "classic" articles in the subspecialty of orthopedic shoulder surgery that can be included in reading curriculums for their trainees.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 04/2012; · 1.93 Impact Factor
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ABSTRACT: Aseptic loosening of the glenoid component after total shoulder arthroplasty presents a considerable treatment challenge in the setting of substantial glenoid bone loss. Glenoid component explantation and bone grafting of defects have become common methods of recreating bone stock in hopes of preventing later fractures, maintaining joint kinematics, and allowing for later glenoid reimplantation if necessary. Although this has been traditionally accomplished via open techniques, this article describes an arthroscopic-assisted method of glenoid explantation and bone grafting for cases of aseptic glenoid loosening with contained bone defects.
Orthopedics 11/2011; 34(11):862-5. · 2.66 Impact Factor
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Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 07/2011; 20(7):1184-90. · 1.93 Impact Factor
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Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 06/2011; 20(6):1016-24. · 1.93 Impact Factor
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ABSTRACT: Obesity is linked to major health conditions and poor surgical outcomes. The impact of obesity on self-perceived outcome after rotator cuff repair (RCR) is unclear.
We studied 154 patients who underwent RCR. Obesity was considered a body mass index (BMI) greater than 30. Preoperative and postoperative evaluations included the Disabilities of the Arm, Shoulder and Hand (DASH), Simple Shoulder Test, and visual analog scales for pain, function, and quality of life. Obese and control patients were compared for baseline demographics, surgical findings, and postoperative outcomes.
Our overall population had a mean BMI of 28.4 (95% confidence interval, 27.7-29.1). There were 57 obese patients (BMI >30) and 97 nonobese patients with 1- or 2-tendon rotator cuff tears. Mean follow-up was 54.8 weeks (range, 52.0-88.7 weeks). Preoperative DASH score was 45.2 for obese patients and 43.4 for control patients (P = .524). The mean improvement in DASH score was 30.7 for obese patients and 26.1 for nonobese patients (P = .152). There were no significant differences in the Simple Shoulder Test and visual analog scale scores. Worse follow-up DASH scores in both groups were associated with worker's compensation status (P = .003) and total comorbidities (P < .001). Multiple linear regression analysis showed that BMI (continuous) and obesity (dichotomous) were not significantly related to outcome after we controlled for confounding variables.
Although obesity is considered a risk factor for poor postoperative outcomes after some surgical procedures, in our experience, obesity does not have an independent, significant effect on self-reported early outcomes after RCR.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 12/2010; 19(8):1250-5. · 1.93 Impact Factor
