Joseph P Iannotti

• MD, PhD
• Chair at Cleveland Clinic

Shoulder arthroplasty is a surgical procedure that is increasingly being used to treat patients with shoulder joint disorders, such as osteoarthritis and rotator cuff tears. Preoperative planning and the accurate transfer of this plan to the surgical procedure are critical for the success of the surgery. Three-dimensional (3D) preoperative planning...

Background This study aimed to identify implant positioning parameters and patient factors contributing to acromial stress fractures (ASFs) and scapular spine stress fractures (SSFs) following reverse shoulder arthroplasty (RSA). Methods In a multicenter retrospective study, the cases of patients who underwent RSA from June 2013 to May 2019 and ha...

With the growth of total shoulder arthroplasty (TSA), surgeons are facing a larger volume of revision arthroplasty cases with reconstructive challenges. Advanced glenoid bone loss is commonly encountered in the revision setting and presents challenges in placing the glenoid component in a location and orientation that maximizes implant fixation, so...

Background Prognostic factors for total shoulder arthroplasty (TSA) clinical outcomes are incompletely understood. This study investigates the associations of preoperative patient, disease-specific, and surgical factors with 1-year postoperative PENN Shoulder Score (PSS) in patients undergoing primary TSA. Methods Cleveland Clinic patients undergo...

Background: Both patient and implant related variables have been implicated in the incidence of acromial (ASF) and scapular spine fractures (SSF) following reverse shoulder arthroplasty; however, previous studies have not characterized nor differentiated risk profiles for varying indications including primary glenohumeral arthritis with intact rot...

Background: Instability after reverse shoulder arthroplasty (RSA) is one of the most frequent complications and remains a clinical challenge. Current evidence is limited by small sample size, single-center, or single-implant methodologies that limit generalizability. We sought to determine the incidence and patient related risk factors for disloca...

Background: This study's purpose was to investigate the extent to which differences among operating surgeons may influence 1-year patient-reported outcome measures (PROMs) in patients undergoing rotator cuff repair (RCR) surgery, after controlling for general and disease-specific patient factors. We hypothesized that surgeon would be additionally...

Purpose of Review As reverse total shoulder arthroplasty indications have expanded and the incidence of its use has increased, developments in implant design have been a critical component of its success. The purpose of this review is to highlight the recent literature regarding the effect of implant design on reverse total shoulder arthroplasty bi...

Background MRI-based rotator cuff assessment is often qualitative and subjective; few studies have tried to validate such preoperative assessments. This study investigates relationships of preoperative MRI assessments made by conventional approaches to intraoperative findings of tear type, location and size or MRI-assessed muscle occupation ratio....

Background Deep tissue culture specimens obtained at the time of revision shoulder arthroplasty are commonly positive for Cutibacterium. Clinical interpretation of positive cultures can be difficult. This was a multi-institutional study evaluating the accuracy of cultures for Cutibacterium using positive control (PC) and negative control (NC) sampl...

Background Most orthopaedic journals currently require reporting outcomes of surgical interventions for at least 2 postoperative years, but there have been no rigorous studies on this matter. Various patient-reported outcome (PRO) measures (PROMs) have been used to assess the status of the shoulder after rotator cuff repair (RCR). Hypothesis We hy...

Glenoid component loosening remains a common complication following anatomic total shoulder arthroplasty; however, plain radiographs are unable to accurately detect early implant migration. The purpose of this study was to validate the accuracy of a method of post‐operative, three‐dimensional (3D) computed tomography (CT) imaging with metal artifac...

Background: Posterior glenoid bone loss is commonly associated with primary glenohumeral osteoarthritis. Surgical management of bone loss in anatomic total shoulder arthroplasty (aTSA) remains controversial. We studied the use of a stepped augmented glenoid component for management of Walch B2 and B3 glenoids and compared the radiographic and clin...

Background: The purpose of this study was to evaluate glenoid component position and radiolucency following anatomic total shoulder arthroplasty (TSA) using sequential 3-dimensional computed tomography (3D CT) analysis. Methods: In a series of 152 patients (42 Walch A1, 16 A2, 7 B1, 49 B2, 29 B3, 3 C1, 3 C2, and 3 D glenoids) undergoing anatomic...

Background MRI is standard-of-care for rotator cuff evaluation, with clinical interpretation usually limited to qualitative judgments. The reliability of MRI–based measurements and scoring systems have been evaluated only preoperatively or ≥6 months following rotator cuff repair (RCR) when repairs are in the later stages of healing. This study desc...

Background: Acromial (ASF) and scapular spine (SSF) stress fractures are well-recognized complications of reverse shoulder arthroplasty (RSA), but much of the current data is derived from single-center or single implant studies with limited generalizability. This multicenter study from the American Shoulder and Elbow Surgeons (ASES) Complications...

Background The purpose of this study was to demonstrate the validity and efficiency of the Outcomes Management and Evaluation (OME) system, a prospectively designed electronic data collection tool, for collecting comprehensive and standardized surgical data in shoulder arthroplasty. Methods Surgical data from the first 100 cases of shoulder arthro...

Objective: To determine whether a simulated low-dose metal artifact reduction (MAR) CT technique is comparable with a clinical dose MAR technique for shoulder arthroplasty evaluation. Materials and methods: Two shoulder arthroplasties in cadavers and 25 shoulder arthroplasties in patients were scanned using a clinical dose (140 kVp, 300 qrmAs);...

Background To address the need for more objective and quantitative measures of tendon healing in research studies, we intend to use computed tomography (CT) with implanted radiopaque markers on the repaired tendon to measure tendon retraction following rotator cuff repair. In our small prior study, retraction at 1-year follow-up averaged 16.1± 5.3...

Background The purpose of this study was to quantify correction of glenoid deformity and humeral head alignment in anatomic total shoulder arthroplasty (TSA) as a function of preoperative pathology (modified Walch classification) and glenoid implant type in a clinical cohort using three dimensional (3D) computed tomography (CT) analysis. Methods P...

Background Glenoid component loosening is a common cause of failure for anatomic total shoulder arthroplasty (TSA). Prior studies of all-polyethylene (PE) hybrid fixation glenoid implants did not show early glenoid radiolucency to be clinically significant. The purpose of this study was to determine the clinical significance of progression of radio...

Introduction There is no current standard by which culture specimens from revision shoulder arthroplasty should be handled, processed, cultured, and reported. Due to the relatively low numbers of cases multicenter study may provide information to form consensus recommendations. However, assimilation of multicenter data requires comparable methodolo...

Hypothesis/Background Shoulder pain and dysfunction are common indications for shoulder arthroplasty, yet the factors that are associated with these symptoms are not fully understood. This study aimed to investigate the associations of patient and disease-specific factors with preoperative patient-reported outcome measures (PROMs) in patients under...

Despite an evolving array of surgical options and technologies available to perform rotator cuff repair, as well as advances in postoperative rehabilitation strategies, reported failure rates remain high, with large-to-massive rotator cuff tears showing higher failure rates than small-to-medium-sized tears. ➢ Preoperative magnetic resonance imaging...

Background Variations in glenoid morphology impact surgical treatment and outcome of advanced glenohumeral osteoarthritis (OA). The purpose of this study was to assess the inter- and intra-observer reliability of the modified Walch classification using three-dimensional (3D) computed tomography (CT) imaging in a multicenter research group. Methods...

Background Shoulder pain and dysfunction are common indications for rotator cuff repair surgery, yet the factors that are associated with these symptoms are not fully understood. Purpose/Hypothesis This study aimed to investigate the associations of patient and disease-specific factors with baseline patient-reported outcome measures (PROMs) in pat...

Purpose The purpose of the study was to describe the characteristics and demonstrate proof-of-concept and clinical use of a barium sulfate infused polypropylene radiopaque tissue marker for soft tissue localization and in vivo measurement of lengths and areas. Methods Marker mechanical properties were evaluated by tensile tests. Biocompatibility w...

Background Glenohumeral osteoarthritis (OA) carries a spectrum of morphology and wear patterns of the glenoid surface exemplified by complex patterns such as glenoid biconcavity and acquired retroversion seen in the B2 glenoid. Multiple imaging methods are available for evaluation of the complex glenoid structure seen in B2 glenoids. The purpose of...

Background: This study tested validity and efficiency of Orthopaedic Minimal Data Set (OrthoMiDaS) Episode of Care (OME). Methods: We analyzed 100 isolated rotator cuff repair cases in the OME database. Surgeons completed a traditional operative note and OME report. A blinded reviewer extracted data from operative notes and implant logs in elect...

Background Nonspherical prosthetic humeral head designs have become increasingly popular as they better approximate the native shoulder anatomy and biomechanical properties and is supported by the existing literature. It remains to be seen how this will impact postoperative outcomes for total shoulder arthroplasty providing a justification for this...

With the increasing use of shoulder arthroplasty, surgeons encounter a greater number of primary and revision cases with glenoid deformity, presenting the challenge of avoiding glenoid component malpositioning that can impact patient function and implant longevity. Surgeons can now use preoperative three-dimensional imaging and templating to better...

Background: Use of 3-dimensional (3D) computed tomography (CT) preoperative planning and patient-specific instrumentation has been demonstrated to improve the accuracy of glenoid implant placement in total shoulder arthroplasty (TSA). The purpose of this study was to compare the accuracy of glenoid implant placement in primary TSA among different...

Background: Improving outcomes after surgical procedures and determining the value of health care can be facilitated by a scientifically valid, cost-effective, and scalable data outcome collection system. We hypothesized that such a system could be constructed in orthopaedic surgery to (1) capture >95% of baseline validated patient-reported outcom...

Infection after shoulder arthroplasty, while representing less than 5% of all complications, can be devastating for the patient. The most common presenting complaint is pain independent of activity, and the diagnosis requires a high degree of suspicion by the treating surgeon. The most common bacteria isolated are Propionibacterium acnes (P. acnes)...

Glenohumeral osteoarthritis can cause significant glenoid bone loss. Asymmetric bone loss in advanced osteoarthritis is primarily posterior resulting in increased retroversion. In contrast, patients with instability-related arthritis may develop anterior glenoid wear and increased anteversion. Walch initially described a three group classification...

Shoulder arthrodesis remains a salvage option for the management of complex problems that cannot be treated with repair or reconstructive options. The indications are often associated with failed prior surgical procedures that result in severe soft tissue loss of the deltoid and rotator cuff or related to nerve injuries associated with these tissue...

Purpose Clinical shoulder science lacks a benchmark against which the early clinical value of new glenoid components can be compared; such a benchmark may be derived from a multicenter study of patients receiving an established, internationally used design of glenoid component. Methods We obtained data from 11 centers on 1270 patients having total...

Background: Value-based payment programs in orthopedics, specifically primary total hip arthroplasty (THA), present opportunities to apply forecasting machine learning techniques to adjust payment models to a specific patient or population. The objective of this study is to (1) develop and validate a machine learning algorithm using preoperative b...

Background: The primary objectives of this study were to evaluate the ability of a posteriorly stepped augmented glenoid component, used in patients with primary glenohumeral osteoarthritis with B2 or B3 glenoid morphology, to correct preoperative retroversion and humeral head subluxation and to identify factors associated with radiographic radiol...

Background: The factors that associate with surgical decisions about repair technique and the number of suture anchors used in rotator cuff repair have not been previously investigated. This study investigated the extent to which patient, surgeon, and surgical factors associate with performing single-row vs. double-row repair technique and ultimat...

* Identifying biomarkers of disease severity and prognostic factors for healing after rotator cuff repair would allow improved clinical decision-making about the treatment of patients with rotator cuff pathologies and possibly identify targets for therapeutic intervention to promote healing. * The state of investigations to identify biomarkers of d...

Background: Revision shoulder arthroplasty in the setting of glenoid bone loss poses substantial surgical challenges. This study's purpose was to compare radiographic and clinical results of patients requiring structural iliac crest bone autograft (ICBA) for severe bone loss versus patients with less severe bone loss treated with nonstructural bon...

Improving value in shoulder arthroplasty has gained increasing importance as procedure volume increases. To enhance the value of shoulder arthroplasty, an improvement of outcomes or a decrease in associated costs must occur. With the recent shift to a value-based care delivery model, analysis of the effects of surgical volume presents an opportunit...

Background: Scapular notching is frequently observed following reverse total shoulder arthroplasty (rTSA), although the etiology is not well understood. Methods: Twenty-nine patients with preoperative computed tomography (CT) scans who underwent rTSA with a Grammont design were evaluated after a minimum of 2 years of follow-up with video motion...

Social media provide a unique method of analyzing outcomes and quality in medicine. The purpose of this observational study was to investigate the nature of social media content related to shoulder and elbow (S&E) surgery posted by patients, surgeons, and hospitals. A public search of Instagram for a two-year period yielded 1,177 patient-related po...

Background: Glenoid morphology and rotator cuff muscle quality are important anatomic factors that can impact longevity of the glenoid component following total shoulder arthroplasty (TSA). We hypothesized that rotator cuff muscle fatty infiltration is associated with increased pathologic glenoid bone loss in glenohumeral osteoarthritis (OA). Met...

Background: Mobile technology offers the prospect of delivering high-value care with increased patient access and reduced costs. Advances in mobile health (mHealth) and telemedicine have been inhibited by the lack of interconnectivity between devices and software and inability to process consumer sensor data. The objective of this study was to pre...

Background: Detection of postoperative component position and implant shift following total shoulder arthroplasty (TSA) can be challenging using routine imaging. The purpose of this study was to evaluate glenoid component position over time using 3-dimensional computed tomography (CT) analysis with minimum 2-year follow-up. Methods: Twenty patie...

Background: A reinforced biologic strip graft was designed to mechanically augment the repair of rotator cuff tears that are fully reparable by arthroscopic techniques yet have a likelihood of failure. This study assessed the extent to which augmentation of human supraspinatus repairs with a reinforced fascia strip can reduce gap formation during...

Background: Hemolysis has been suggested as a feature conferring increased pathogenicity to certain Propionibacterium acnes strains in the setting of shoulder infection. The purpose of this study was to compare the virulence of hemolytic and nonhemolytic P acnes strains in patients undergoing revision shoulder arthroplasty. Methods: Thirty-nine...

Background: Walch defined the pathologic characteristics of glenohumeral osteoarthritis on the basis of patterns of glenoid morphology and humeral head subluxation. However, it is unclear how pathologic changes evolve over time. The purpose of this study was to determine whether there are common patterns of pathologic progression based on the Walc...

Background: Our goal was to determine whether readmissions within 30 or 90 days following discharge are associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for total hip arthroplasty (THA) patients. Methods: HCAHPS surveys from all patients who underwent THA between January 2016 and September 2016 in...

Background: Diagnosing infection after shoulder arthroplasty can be a challenge because of the high prevalence of low-virulence organisms, such as Propionibacterium acnes. The purpose of this study was to evaluate the utility of implant sonication fluid cultures in the diagnosis of periprosthetic joint infection compared with standard culture tech...

Introduction: Three-dimensional (3D) templating of the glenoid in anatomic shoulder arthroplasty allows for more accurate planning and more optimal positioning of the glenoid component than 2-dimensional computed tomography (2D CT) scans through an improved understanding of both the pathologic and the premorbid glenoid joint line, version, and inc...

The annual volume of rotator cuff repairs in the United States is roughly 250,000, and failure rates still range from 20% to 70% in most studies despite significant advances in surgical technique and rehabilitation protocols. Even many "healed" repairs continue to have pain, weakness, and dysfunction, a phenomenon that may be explained by "Failure...

Background: Osteoarthritis of the glenohumeral joint has typical patterns of deformity as described by Walch et al. However, more severe glenoid pathology may be difficult to classify. The purpose of this study was to use 3-dimensional computed tomography (3-D CT) imaging analysis to define common pathologic subtypes that can be differentiated fro...

Background Whereas several studies suggest that high-volume surgeons and hospitals deliver superior patient outcomes with greater cost efficiency, no evidence-based thresholds separating high-volume surgeons and hospitals from those that are low or medium volume exist in shoulder arthroplasty. The objective of this study was to establish meaningful...

The purpose of this study was to demonstrate feasibility of a clinical CT imaging and analysis technique to quantify regional variations in trabecular bone architecture and mineralization of glenoid bones. Specifically, our objective was to determine to what extent clinical CT imaging of intact upper extremities can describe variations of trabecula...

Periprosthetic joint infection is one of the most serious complications associated with arthroplasty surgery and poses great diagnostic difficulty. Traditional diagnostic methods used to diagnosis infection in the lower extremity are less accurate for shoulder prosthetic joint infection due to the indolent nature of the most common pathogen, Propio...

3D imaging and implant templating along with patient specific instrumentation improves the accuracy of bone preparation and placement of the glenoid implant when compared to 2D imaging without templating. Various type of patient specific instrumentation have been created. To date all provide equal accuracy. Some types of patient specific instrument...

Introduction: The most common reported complications with RSA have been instability and infection, with higher rates of infection reported in RSA than anatomic shoulder replacement. This chapter focuses on the application of RSA in the setting of infection, including a review of the literature and outcomes, preferred method of treatment, and key po...

Background: Periprosthetic joint infection (PJI) after shoulder arthroplasty can present a diagnostic and therapeutic challenge. This study evaluated the diagnostic utility of broader synovial fluid cytokine analysis for identifying PJI in patients undergoing revision shoulder arthroplasty. Methods: Synovial fluid levels of 9 cytokines (interleu...

Purpose The role of reverse total shoulder arthroplasty (RTSA) for three and four-part proximal humerus fractures is evolving. However, there does not appear to be a clear consensus amongst surgeons. The purpose of this study is to further define the standard of care, assessing surgeon preference and treatment considerations for management of such...

Objective: The purpose of this study was to compare iterative metal artifact reduction (iMAR), a new single-energy metal artifact reduction technique, with filtered back projection (FBP) in terms of attenuation values, qualitative image quality, and streak artifacts near shoulder and hip arthroplasties and observer ability with these techniques to...

Background: Minimal information is currently available on the outcome of rotator cuff repair reinforced with an extracellular matrix (ECM) graft. Therefore, the purpose of this study was to determine the clinical and radiographic outcome of repair of large rotator cuff tears with ECM graft reinforcement. Methods: This was a prospective study of...

INTRODUCTION: Scapular notching is frequently observed following reverse total shoulder arthroplasty (rTSA), although its etiology and significance are not entirely understood. We have developed a three -dimensional (3D) computed tomography (CT) computer simulation model that uses patient-specific range of motion (ROM), bony anatomy, and implant lo...

Glenohumeral osteoarthritis produces a wide spectrum of glenoid pathology. The B2 glenoid is defined by asymmetric posterior bone loss with the development of a biconcavity and posterior translation of the humeral head. Progressive bone loss results in increasing glenoid retroversion, which must be corrected during anatomic shoulder arthroplasty. T...

Background: A non-spherical humeral head has been shown to influence kinematics and stability of the glenohumeral joint; yet, most prosthetic humeral head components are designed to be a perfect sphere. The effect of humeral head shape on prosthetic joint kinematics after total shoulder arthroplasty is not well understood. We hypothesized that pro...

Background and hypothesis: Deltoid disruption has traditionally been an absolute contraindication to performing a reverse total shoulder arthroplasty (RTSA), and options available to patients have been limited. We present a series of patients with deltoid tears that underwent concomitant RTSA with deltoid reconstruction. We hypothesize that this c...

The ideal treatment for malunions of the proximal humerus is prevention by proper ­management of acute injuries. However, despite proper management, symptomatic malunion may occur and can be disabling due to pain, loss of motion, and lack of function. Surgical management of a symptomatic malunion can include both open and arthroscopic techniques, a...

Areas of current controversy concerning shoulder arthroplasty include management of glenoid bone loss, the role of patient-specific instrumentation, differing design features of reverse shoulder arthroplasty, and options for humeral fixation in primary and revision procedures. At the 2015 meeting of the American Academy of Orthopaedic Surgeons, sho...

OBJECT High-resolution magnetic resonance imaging (MRI) can distinguish between intraneural ganglion cysts and paralabral (extraneural) cysts at the glenohumeral joint. Suprascapular intraneural ganglion cysts share the same pathomechanism as their paralabral counterparts, emanating from a tear in the glenoid labrum. The authors present 2 cases to...

Patient satisfaction is increasingly being tied to reimbursement rates, and patient satisfaction is often associated with improving functionality and decreasing disability postoperatively. This study sought to determine if a total shoulder arthroplasty patient's preoperative confidence in his or her ability to attain the level of activity desired w...

Background: Propionibacterium acnes is recognized as a pathogenic organism associated with periprosthetic joint infection following shoulder arthroplasty. The goal of our study was to determine the relationship between the time to P. acnes growth in culture and the likelihood of a culture result being a true positive versus a false positive based...

Each year, 250,000 rotator cuff repairs are performed in the United States at a cost of $3 billion. Despite advancements in repair techniques and rehabilitation, 20%–70% of repairs continue to undergo structural failure; however, there is a poor correlation between clinical and structural outcomes, both before and after surgery. “Failure in continu...

Stemless humeral fixation has become an alternative to traditional total shoulder arthroplasty, but metaphyseal fixation may be compromised by the quality of the trabecular bone that diminishes with age and disease, and augmentation of the fixation may be desirable. The authors hypothesized that a bone graft substitute (BGS) could achieve initial f...

A directed structure placement guide assists with positioning at least one directed structure in at least one of a predetermined insertion trajectory and a predetermined insertion location with respect to a patient tissue surface during preparation of the patient tissue surface to receive an implant. The implant has a tissue-contacting surface. A g...

A positioning apparatus for guiding resection of a patient tissue and guiding placement of a prosthetic implant component in a desired implant position with respect to the resected patient tissue and method of use are described. A locating block includes a mating surface contoured for mating contact with the patient tissue. A cutting plane indicato...

Background: Preoperative quantitative assessment of glenoid bone loss, selection of the glenoid component, and definition of its desired location can be challenging. Placement of the glenoid component in the desired location at the time of surgery is difficult, especially with severe glenoid pathological conditions. Methods: Forty-six patients w...

Background: Measurement of clinical outcomes is necessary to define best practice. It requires a validated tool that can be easily applied as part of clinical practice. We present the preliminary validation of a brief self-reported Review of Musculoskeletal System (ROMS) questionnaire that captures functional limitations due to musculoskeletal pro...

A reamer for use in performing arthroplasty includes a first cutting structure having an inner concave surface that defines a first cavity and terminates in a generally circular leading edge. The inner concave surface includes a first cutting feature that is spaced apart from the leading edge. An elongate member extends from the first cutting struc...

Diagnosis of periprosthetic joint infection (PJI) in revision shoulder arthroplasty can be challenging because of the indolent nature of the common offending organisms. The purpose of this study was to evaluate the diagnostic utility of synovial fluid α-defensin levels in identifying PJI of the shoulder. Thirty patients evaluated for painful should...