BACKGROUND: Glenoid wear secondary to primary osteoarthritis or rotator cuff arthropathy is an obstacle commonly encountered by surgeons performing reverse shoulder arthroplasty, with numerous techniques devised to address this finding. The most recent of such techniques is the introduction of augmented glenoid baseplates to fill these glenoid defects. The objectives of this systematic review are to analyze clinical outcomes of augmented baseplates in patients with glenoid wear, including pain, range of motion, patient-reported functional scores, radiographic outcome measures, complication rates, and revision rates. METHODS: Three online databases (Ovid Medline, EMBASE, Pubmed) were searched for studies publishing clinical and functional outcomes of augmented baseplates in primary reverse shoulder arthroplasty. Findings were aggregated and frequency-weighted means of these variables were calculated when applicable. RESULTS: Seven studies comprising 810 patients were included in this review. The mean patient age was 72.1 ± 8.1 years with an average follow-up time of 41.4 months. Frequency-weighted means of improvement in forward elevation, abduction, and active external rotation were 53°, 47°, and 19°, respectively. Patients experienced American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Constant score improvements of 45.9, 5.9, and 33.7, respectively. Pooled complicated rate was 6.4%, with 10 cases of baseplate loosening and 3 cases of instability. Five (0.6%) patients required reoperation. Subdividing among augment type (posterior, superior, posterosuperior), there were no apparent differences in outcomes or complication rates between directional augments. CONCLUSION: This systematic review demonstrates that augmented baseplates for reverse shoulder arthroplasty provide positive outcomes both clinically and functionally at early follow-up. Complications are within an acceptable range for primary reverse shoulder arthroplasty, with a low rate of revision. Augmented baseplates should serve as a viable option for surgeons seeking to address glenoid wear during reverse shoulder arthroplasty.

Hamstring tendons are a very commonly used autograft for anterior cruciate ligament (ACL) reconstruction. Given that larger hamstring graft diameter has been shown to positively affect outcomes after ACL reconstruction, several techniques have been developed to optimize this variable. In this technical note, we describe the operative technique for generation of a 5-strand hamstring autograft via tripling of the semitendinosus tendon and doubling of the gracilis tendon, which can serve to maximize graft diameter, especially in patient populations with undersized hamstring tendons at baseline.

BACKGROUND: There is currently no consensus regarding the optimal anesthetic technique for total hip and knee arthroplasty (THA, TKA). This study aimed to compare the utilization rates and safety of spinal vs. general anesthesia in contemporary THA/TKA practice. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), a retrospective review of 307,076 patients undergoing total hip or knee arthroplasty under either spinal or general anesthesia between January 2015 and December 2018 was performed. Propensity matching was used to compare differences in operative times, hospital length of stay, discharge destination, and 30-day adverse events. The annual utilization rates for both techniques between 2011 and 2018 were also assessed. RESULTS: Patients receiving spinal anesthesia had a shorter length of stay (P < 0.001) for TKA while no statistical differences in length of stay were observed for THA. Patients were also less likely to experience any 30-day complication (OR = 0.82, P <0.001 and OR = 0.92, P < 0.001 for THA and TKA, respectively) while being more likely to be discharged to home (OR = 1.46, P < 0.001 and OR = 1.44, P < 0.001 for THA and TKA, respectively). Between 2011 and 2018, spinal anesthesia utilization only increased by 1.4% for THA (P < 0.001) and decreased by 0.2% for TKA (P < 0.001), reaching 38.1% and 40.3%, respectively. CONCLUSION: Spinal anesthesia remains a grossly underutilized tool despite providing better perioperative outcomes compared to general anesthesia. As orthopedic surgeons navigate the challenges of value-based care, spinal anesthesia represents an invaluable tool that should be considered the gold standard in elective, primary total hip and knee arthroplasty.

BACKGROUND: It has been argued that the use of artificial turf football fields in the National Football League (NFL) increases player injury risk compared with natural grass surfaces. PURPOSE/HYPOTHESIS: The purpose of this study was to quantify the rate of lower extremity injuries occurring in NFL players on artificial turf compared with natural grass surfaces and characterize the time missed due to injury and proportion of injuries requiring surgery. It was hypothesized that lower extremity injuries requiring surgical intervention would occur at a higher rate on artificial turf than on natural grass. STUDY DESIGN: Descriptive epidemiology study. METHODS: Lower extremity injury data for the 2021 and 2022 NFL seasons were obtained using publicly available records. Data collected included injury type, player position, player age, playing surface, weeks missed due to injury, and whether the patient underwent season-ending or minor surgery. Multivariable logistic regression was performed to determine the risk of season-ending surgery according to playing surface. RESULTS: When combining injuries for the 2021 and 2022 seasons (N = 718 injuries), the incidence rate of lower extremity injury was 1.22 injuries/game for natural grass and 1.42 injuries/game for artificial turf. The odds of a season-ending surgery were found to be significantly higher on artificial turf compared with natural grass (odds ratio = 1.60; 95% CI, 1.28-1.99; P < .05), while additional variables, including weather, age, position, week of injury occurrence, and history of prior injury, did not influence the odds of season-ending surgery. CONCLUSION: The 2021 and 2022 NFL seasons of our analysis demonstrated a higher incidence rate of injuries on artificial turf surfaces compared with natural grass surfaces. In addition, the odds of injury requiring season-ending surgery were found to be significantly higher on artificial turf compared with natural grass.

Introduction

Symptomatic hip osteoarthritis (OA) causes significant morbidity and functional limitations. While corticosteroid injections (CSI) are commonly offered and administered for OA pain relief, it is unknown if they offer any clinically meaningful long-term benefit or reduce the overall need for surgical intervention.

Methods

A cross-sectional retrospective cohort study was performed on primary hip osteoarthritis patients from a single academic tertiary-care center arthroplasty clinic from 2014 to 2019. Patients were divided into three groups. CSI + THA: hip CSI patients who underwent subsequent ipsilateral THA. CSI-noTHA: hip CSI who have not had ipsilateral THA to date. THA-noCSI: a control group of consecutive hip OA patients who underwent primary THA without prior CSI. Demographic variables, injection relief duration, and radiographic arthritis severity were recorded. Time from clinic presentation to injection and/or THA were compared.

Results

357 patients met inclusion criteria and underwent guided, arthroplasty provider-ordered CSI. Mean duration of relief was 6.7 weeks (SD 8.7). 244 injection patients (67.2%) subsequently underwent THA (CSI + THA). 150 of 390 patients have not undergone THA at mean of 25.5 months follow-up. Mean time from clinic presentation to THA was 8.6 months longer after CSI (16.3, SD 17.8) months in CSI patients compared to 7.7 (SD 10.6) months for patients without CSI (p < 0.001). Of 117 patients in the CSI-noTHA group at mean 25 months follow-up, only 43 (12% of all injection patients) had not had THA because they found injections effective. The remaining 74 (63%) of CSI-noTHA patients have been deemed medically unfit for surgery or are currently scheduled for THA.

Discussion/conclusion

The results of this study suggest the utilization of intra-articular CSI as conservative treatment in an arthroplasty clinic does not prolong time to THA for a clinically important duration. The use of CSI should be reserved for diagnostic purposes and/or short-term pain relief in poor surgical candidates.

Level of evidence

III.