Thomas W. Wright

Thomas W. Wright
University of Florida | UF · Department of Orthopaedics and Sports Medicine

Doctor of Medicine

About

327
Publications
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11,294
Citations

Publications

Publications (327)
Article
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Background Many surgeons and practices have adopted age cutoffs for performing TSA. The purpose of this study was to determine whether there exists an age cutoff of increased risk for 30-day medical complications, unplanned readmissions, and death after elective total shoulder arthroplasty (TSA). Methods The American College of Surgeons National Su...
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Background: Reverse shoulder arthroplasty (RSA) is increasingly used in the treatment of displaced proximal humerus fractures (PHFs) with reliable clinical improvement. However, the preferred techniques for humeral stem fixation are varied and may be influenced by patient and injury characteristics, including bone quality and fracture pattern. Thi...
Article
Aims We sought to compare functional outcomes and survival between non-smokers, former smokers, and current smokers who underwent anatomical total shoulder arthroplasty (aTSA) in a large cohort of patients. Methods A retrospective review of a prospectively collected shoulder arthroplasty database was performed between August 1991 and September 202...
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Purpose This systematic review and meta-analysis compared clinical outcome measures in patients undergoing reverse shoulder arthroplasty (RSA) for proximal humerus fracture (PHF) with healed versus non-healed greater tuberosity (GT). Methods We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyse...
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» Instability and dislocation after reverse shoulder arthroplasty may occur in up to 31% of patients. » Clinical risk factors for instability include younger age, male sex, increased body mass index, preoperative diagnosis of proximal humerus fracture or rotator cuff pathology, history of instability of the native shoulder or after surgery, and a m...
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Background As no consensus exists on the optimal postoperative rehabilitation protocol in terrible triad injuries, we sought to characterize the reported protocols and relate them to postoperative range of motion (ROM) measures and Mayo Elbow Performance Score (MEPS). Methods A systematic review was performed by searching PubMed/MEDLINE, Embase, W...
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Background This study sought to determine if preoperative forward elevation (FE) weakness affects outcomes of anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) for patients with rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA). Methods A retrospective review of a single institution’s prospectively collected shoulder arthropla...
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Background Improper sizing of the humeral head component in anatomic total shoulder arthroplasty (ATSA) can overstuff the joint, potentially compromising outcomes. The purpose of this study was to validate a novel method of evaluating glenohumeral joint overstuffing in which superoinferior and mediolateral overstuffing can be evaluated independentl...
Article
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...
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Context: Elbow medial ulnar collateral ligament (UCL) injuries have become increasingly common in athletes. Despite this, rehabilitation protocols appear to vary drastically, which may explain the clinical equipoise regarding optimal management. Objective: This systematic review reports rehabilitation characteristics reported after UCL injuries and...
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» Biomechanical studies report that thin scapular spine (SS) morphology, superiorly placed glenoid components, and increased glenoid baseplate screws contribute to increased acromial and SS strain and may increase fracture risk. » Clinical risk factors of acromial and SS fractures after reverse shoulder arthroplasty include increasing age, female s...
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Background Newer generation humeral stem designs in total shoulder arthroplasty (TSA) are trending towards shorter lengths and uncemented fixation. The goal of this study is to report a 2-yr minimum clinical and radiographic outcomes of an uncemented short-stem press-fit humeral stem in anatomic total shoulder arthroplasty (ATSA) and reverse total...
Article
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...
Article
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...
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Purpose Accurate glenoid component placement in total shoulder arthroplasty (TSA) remains challenging even with preoperative planning, especially for variable glenoid erosion patterns in the coronal plane. Methods We retrospectively reviewed 170 primary TSAs in which preoperative planning software was used. After registration of intraoperative bon...
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Background: Reverse total shoulder arthroplasty (rTSA) has begun to challenge the place of anatomic total shoulder arthroplasty (aTSA) as a primary procedure for certain indications. One purported benefit of aTSA is improved postoperative range of motion (ROM) compared to rTSA especially in internal rotation; however, it is unclear whether aTSA ca...
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Introduction: Early reverse total shoulder arthroplasty (rTSA) designs had high failure rates, mainly from loosening of the glenoid baseplate. The purpose of this study is to determine the incidence of aseptic glenoid baseplate loosening after primary rTSA using a contemporary medialized glenoid/lateralized humeral system and identify significant...
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Background: Extensive proximal humeral bone loss in the setting of shoulder arthroplasty represents a difficult challenge for the treating surgeon. Achieving adequate fixation with standard humeral prostheses can be problematic. Allograft-prosthetic composites are a viable solution for this problem, however high rates of complications have been re...
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Background: Identifying risk factors for acromial and scapular fractures improves our understanding about which variables are relevant to this fracture complication; however, this data is difficult to integrate into clinical practice because the majority of rTSA patients have 1 or more risk factors. The goal of this study is to better facilitate p...
Chapter
Avascular necrosis (AVN) of the humeral head typically affects relatively young patients in their second to fifth decades of life. In most cases, it is gradually progressive, and surgical intervention is frequently indicated. Core decompression has been shown to be a successful joint preservation surgery in early-stage disease. However, this alone...
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Introduction: Changes in pre- to postoperative outcome scores are often used to quantify success after anatomic total shoulder arthroplasty (aTSA). However, ceiling effects associated with many outcome scores limit the ability to differentiate success among high-functioning patients. The percent maximal possible improvement (%MPI) was introduced t...
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Background: The goal of this longitudinal analysis of aTSA and rTSA utilization from 2007-2021 is to quantify changes in clinical outcomes, cost, and value, resulting from the introduction and adoption of new shoulder arthroplasty technologies. Methods: We analyzed an international database of a single shoulder arthroplasty prosthesis (Equinoxe;...
Article
Background: Persistent shoulder pain and dysfunction after vaccination are relatively rare but well-known complications after inoculations into the deltoid muscle. The term SIRVA (shoulder injury related to vaccine administration) is frequently used to encompass many of these occurrences; however, multiple distinct pathologies with similar present...
Article
Background: Deltoid tensioning secondary to humeral lengthening after reverse shoulder arthroplasty (RSA) is commonly theorized to be crucial to improving range of motion (ROM) but may predispose patients to acromial/scapular spine fractures and neurologic injury. Clinical evidence linking patient outcomes to humeral lengthening is limited. This st...
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Background Both anatomic and reverse total shoulder arthroplasty (aTSA and RTSA) are being increasingly performed. In the event of a complication necessitating revision, RTSA is more commonly performed in both scenarios. The purpose of this study was to compare clinical outcomes between patients undergoing revision RTSA for failed primary anatomic...
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Background: While most patients undergoing reverse total shoulder arthroplasty (rTSA) have substantial improvement in pain and function at early follow-up, improvements in pain and range of motion (ROM) progress more slowly during postoperative rehabilitation in a subset of patients. The purpose of this study was to define a patient's risk of pers...
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Background: The expansion of indications for reverse total shoulder arthroplasty (RTSA) has resulted in a rapid increase in the incidence of subsequent revision procedures. The purpose of this study was to identify the incidence and risk factors for re-revision shoulder arthroplasty after first revision RTSA. Methods: We retrospectively queried...
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»: Benzoyl peroxide (BPO) 5% has been shown to reduce Cutibacterium acnes load on the skin. BPO 5% with miconazole nitrate (MN) 2% may be beneficial, whereas BPO 5% with clindamycin cream 1% to 1.2% does not seem to have additive effects when compared with BPO 5% alone. Chlorhexidine gluconate solutions reduce the total bacterial load on the skin,...
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Background Nerve injury following reverse shoulder arthroplasty (RSA) is a known risk factor with wide ranging incidences reported. This systematic review evaluates the overall incidence of nerve injury following primary and revision RSA and summarizes the characteristics of the nerve injuries reported in the current literature. Methods A systemat...
Article
Background Intraoperative complications after shoulder arthroplasty (SA) are uncommon, yet surgeons continue to obtain immediate postoperative radiographs despite prior literature questioning the efficacy of these images. There is a paucity of literature describing the role of immediate postoperative radiographs for revision SA. This study aimed to...
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Background: The Shoulder Arthroplasty Smart (SAS) score is a new, validated machine learning-derived outcome measure that requires six input parameters. The SAS score has the potential to replace legacy shoulder outcome scores. Methods: We conducted a retrospective review of a multinational shoulder arthroplasty database of one platform shoulder...
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Introduction: This study's purpose is to compare clinical and radiographic outcomes of primary anatomic total shoulder arthroplasty (aTSA) and primary reverse total shoulder arthroplasty (rTSA) patients with osteoarthritis (OA) and an intact rotator cuff with no previous history of shoulder surgery using a single platform TSA system at a minimum f...
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Background The role of reverse total shoulder arthroplasty (rTSA) for glenohumeral osteoarthritis (GHOA) with an intact rotator cuff remains unclear with prior investigations demonstrating similar patient reported outcome measures (PROMs) to anatomic total shoulder arthroplasty (aTSA). However, legacy PROMs are subject to skewed distributions with...
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Background Literature on radiation exposure with use of the mini C-arm and value of having built-in laser guidance is limited. The purpose of this study was to determine whether laser guidance use on a mini C-arm fluoroscopy unit can reduce radiation exposure. Methods Surgeons (N = 25) performed the same simulated surgical task, which involved obt...
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Introduction While lateralization of the glenohumeral center of rotation during reverse shoulder arthroplasty (RSA) has benefits of maintaining tension on the remaining rotator cuff and decreasing implant impingement on the glenoid, few clinical studies have evaluated the isolated effect of glenoid lateralization in RSA. The purpose of this study w...
Article
Background Glenoid component positioning remains a challenge during total shoulder arthroplasty (TSA). While preoperative 3D planning software is widely available for most TSA systems today, the degree to which this software affects surgeon preoperative and intra-operative decision making is unknown. The purpose of the study is to determine if surg...
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Background The purpose of this study was to examine the influence of preoperative marijuana use on postoperative opioid use during the first three postoperative days (POD 1–3) after surgery, and on expectations of pain control, resiliency, and quality-of-life scores.Methods All patients presenting to a single institution undergoing elective hand or...
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Introduction Both anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty are the standard of care for various end-stage degenerative conditions of the glenohumeral joint. The purpose of this prospective study is to compare clinical outcomes of aTSA and rTSA using the same platform TSA system at a minimum follow-up of eight years. Methods A...
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Background Patient survivorship and risk factors of mortality after reverse total shoulder arthroplasty (RTSA) are seldom and inadequately studied. The purpose of this study was to evaluate the mortality rates and predictors of 1-year and overall mortality after RTSA. Methods We retrospectively reviewed 1518 consecutive adult patients that underwe...
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Background Accurate placement of the glenoid baseplate is an important technical goal of reverse total shoulder arthroplasty (RSA). The use of computer navigated instrumentation has been shown to improve the accuracy and precision of intraoperative execution of preoperative planning. The purpose of this study was to compare early clinical outcomes...
Article
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PurposeGlenoid loosening is a common failure mechanism of anatomic total shoulder arthroplasty (TSA). New hybrid fixation glenoids allow bony ingrowth and decrease the rates of glenoid loosening. The purpose of this study is to describe a new failure mode of polyethylene dissociation from the ingrowth cage in a single implant design.MethodsA retros...
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Background Studies to date evaluating biceps tenotomy versus tenodesis in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes. Hypothesis It was hypothesized that a significant difference could be demonstrated for pain and functional outcome scores comparing biceps tenotomy vers...
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Introduction Glenoid baseplate augments have recently been introduced as a way of managing glenoid monoplanar or biplanar abnormalities in reverse shoulder arthroplasty (RSA). The purpose of this study is to evaluate the difference in clinical outcomes, complications, and revision rates between augmented and standard baseplates in RSA for rotator c...
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Background Periprosthetic proximal humerus fractures (PPHFs) are a detrimental complication of shoulder arthroplasty, yet their characterization and management have been poorly studied. We aimed to determine the intra- and inter-observer reliability of four previously described PPHF classification systems to evaluate which classifications are the m...
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Background: Previous studies have demonstrated that decreased impingement-free range of motion (ROM) can adversely influence clinical outcomes following reverse shoulder arthroplasty (RSA). Inferior placement of the glenosphere is thought to minimize impingement and its associated sequelae. This study evaluates the relationship between inferior ov...
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Purpose Mixed modalities are frequently utilized in total shoulder arthroplasty (TSA) to control pain, improve patient satisfaction, reduce narcotics use and facilitate earlier discharge. We investigate the relationship between early postoperative pain control and long-term functional outcomes after shoulder arthroplasty. Methods A retrospective r...
Article
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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 primar...
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Purpose To evaluate the effect of prior anterior shoulder instability surgery (SIS) on the outcomes and complications of primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA). Methods Between 2007 and 2018, 38 primary total shoulder arthroplasties (TSA) (22 aTSA and 16 rTSA) with a prior SIS and a minim...
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Background Legacy shoulder outcome scores have postoperative ceiling scores effects when quantifying clinical outcomes for anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty patients. This study utilizes data from an international database of a single shoulder prosthesis utilizing data from 30 different clinical sites to quantify and co...
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Introduction: We aimed to determine whether preoperative shoulder strength predicts postoperative values and improvement in strength, range of motion (ROM), and outcome scores after primary reverse total shoulder arthroplasty (rTSA). Methods: We retrospectively reviewed 264 shoulders with a minimum of 2-year follow-up after primary rTSA. Preoper...
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Background: Accurate glenoid component placement in shoulder arthroplasty is often difficult even with the use of preoperative planning. Computer navigation and patient-specific guides increase component placement accuracy, but which patients benefit most is unknown. Our purpose was to assess surgeons' accuracy in placing a glenoid component in vi...
Article
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Background The rate at which patients regain shoulder strength after anatomic and reverse total shoulder arthroplasty (TSA) is unknown. In this study, we aimed to quantify differences in the timeline during which patients gained shoulder strength after primary anatomic and reverse TSA. Methods We retrospectively reviewed prospectively collected da...
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Background Little is known about the role of disorders of the acromioclavicular joint (ACJ) and how they relate to complications after reverse shoulder arthroplasty (RSA). The purpose of this study is to compare the severity of ACJ osteoarthritis in RSA patients with and without postoperative acromial and scapular spine fractures. Methods A retros...
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Background: Rotator cuff tears and glenoid loosening remain the two most common causes for revision after anatomic total shoulder arthroplasty. Oversizing of the humeral head leads to increased contact force across the glenohumeral joint and is hypothesized to contribute to clinical and radiographic failure. The purpose of this study is to compare...
Article
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Introduction Reverse total shoulder arthroplasty (RTSA) is a procedure growing in prevalence among younger populations. Consequently, its use in revision arthroplasty is growing in this demographic. However, studies examining the functional outcomes of revision RTSA in younger populations compared to older populations are lacking. The primary purpo...
Article
Introduction Avascular Necrosis (AVN) of the humeral head frequently results in humeral head collapse and end-stage arthritic changes of the glenohumeral joint. Despite the recent proliferation of reverse shoulder arthroplasty (RTSA), reports on the use of RTSA for AVN remain limited. The purpose of this study was to document the outcomes of should...
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Background Higher blood transfusion rates have been reported in revision shoulder arthroplasty compared to primary arthroplasty. This study seeks to evaluate factors associated with blood transfusions after revision shoulder arthroplasty and to evaluate the effectiveness of tranexamic acid (TXA) to reduce blood transfusion rates in revision shoulde...
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Introduction: Rotator cuff repair (RCR) is commonly performed before reverse shoulder arthroplasty (RSA) with conflicting evidence on the effect on arthroplasty outcomes. The purpose of this investigation was to evaluate the effect of a prior RCR on the outcomes and complications of primary RSA. Methods: Between 2007 and 2017, 438 RSAs performed...
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Background Many patient-reported outcome measures (PROMs) have been used to follow clavicle fractures, providing an objective means to track outcomes. However, lack of standardization of PROM usage makes cross-study comparison difficult. Therefore, we reviewed articles on clavicle fractures from eleven of the most influential orthopedic journals to...
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Purpose The purpose of this study is to present surgical outcomes following humeral head allograft augmentation and glenoid based procedures in patients with active, uncontrolled seizure activity and anterior shoulder instability. Methods A retrospective review of a surgical database for active seizure disorder patients with recurrent shoulder ins...
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Introduction We use machine learning to create predictive models from preoperative data to predict the Shoulder Arthroplasty Smart (SAS) score, the American Shoulder and Elbow Surgeons (ASES) score, and the Constant score at multiple postoperative timepoints and compare the accuracy of each algorithm for anatomic (aTSA) and reverse (rTSA) total sho...
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Background: While numerous preoperative factors that influence postoperative outcomes after anatomic total shoulder arthroplasty (aTSA) have been identified, preoperative shoulder strength has not been studied. The purpose of this study was to determine if preoperative shoulder strength is predictive of postoperative outcomes and improvement after...
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Background Gradual loss of overhead range of motion (ROM) has been observed following reverse shoulder arthroplasty (RSA). It remains unclear if this is caused by the effect of RSA design on muscle fiber lengthening or is part of the natural aging process of the shoulder musculature. Although studies have attempted to evaluate deltoid fatigue after...
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Background Glenoid wear is a common challenge in patients undergoing reverse total shoulder arthroplasty (rTSA). Augmented baseplates have recently been designed to address this. The purpose of this study is to determine the clinical outcomes, complications, and revision rates of patients undergoing rTSA with an augmented baseplate compared to thos...
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Introduction: Patient dissatisfaction after primary reverse total shoulder arthroplasty (rTSA) has been reported as high as 9%. In patients with excessive thoracic kyphosis, the scapula protracts and tilts anteriorly, which may lead to early impingement with the acromion and loss of forward elevation. The primary purpose of this study was to evalu...
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Rotator cuff pathology is the most common shoulder condition for which patients seek treatment. Schmidt et al covered the relevant anatomy, natural history, nonsurgical and surgical treatment, biological augmentation, and postoperative rehabilitation in their comprehensive review published in 2015. This current review builds upon the last update, d...
Article
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...
Article
Background: Reverse shoulder arthroplasty (RTSA) is a successful procedure, often allowing patients to achieve better range of motion (ROM) compared to their preoperative baseline. However, there is a subset of patients who either fail to improve or lose ROM postoperatively. These patients are at increased risk of poor satisfaction and patient rep...
Article
Background : Few studies have evaluated the outcomes of glenoid baseplate migration after reverse shoulder arthroplasty (RSA). The question is whether an ingrowth central cage implant that has undergone early migration can restabilize due to cage ingrowth. The primary purpose of this study is to evaluate the radiographic factors associated with gle...
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Background : An important psychometric parameter of validity that is rarely assessed is predictive value. In this study we utilize machine learning to analyze the predictive value of 3 commonly used clinical measures to assess 2-year outcomes after total shoulder arthroplasty (TSA). Methods : XGBoost was used to analyze data from 2,790 TSA patient...
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Avascular necrosis is a relatively common entity that affects the proximal humerus and can lead to substantial morbidity. It often occurs in younger patients for whom the traditional treatment of shoulder arthroplasty is not optimal. Fibular strut grafting to prevent humeral head collapse has been described as a viable treatment option. However, it...
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Background We propose a new clinical assessment tool constructed using machine learning, called the Shoulder Arthroplasty Smart (SAS) score to quantify outcomes following total shoulder arthroplasty (TSA) Methods Clinical data from 3,667 TSA patients with 8,104 postoperative follow-up reports were used to quantify the psychometric properties of va...