Shoulder and Elbow Recent Publications

This study examined what factors drive hospital costs and influence patient outcomes following revision shoulder arthroplasty, a surgery to replace or correct a previously implanted shoulder joint. Researchers analyzed data from 110 patients who underwent single-stage revision surgery for non-infectious implant failure at a single institution, with at least two years of follow-up. The average inpatient cost was approximately $11,800, and key predictors of higher costs included greater preoperative pain, undergoing reverse shoulder arthroplasty or total shoulder arthroplasty compared to hemiarthroplasty, and having had a prior revision surgery. Implant-related expenses were the primary cost driver, and the cost needed to achieve a meaningful improvement in patient-reported outcomes was substantially higher than what has been reported for primary shoulder replacement. These findings highlight the significant economic burden of revision shoulder arthroplasty and may help surgeons and healthcare systems better anticipate costs and counsel patients about expected outcomes.

This study evaluated how accurately two popular AI chatbots, ChatGPT and Gemini, answer patient questions about common knee injuries — specifically anterior cruciate ligament (ACL) tears and meniscal injuries — by comparing their responses to official clinical guidelines from the American Academy of Orthopaedic Surgeons (AAOS). Researchers asked both AI tools questions based on established evidence-based recommendations and had two reviewers independently rate whether each response agreed, was neutral, or disagreed with those guidelines. ChatGPT aligned with 82% of the strong and moderate recommendations, while Gemini aligned with 73%, and both performed perfectly when answering questions related to meniscal injury guidelines. Notably, Gemini cited 25 published research articles to support its answers, with 23 being relevant and accurate, while ChatGPT provided no references at all. These findings suggest that while AI chatbots generally offer patients reliable, guideline-consistent information about knee injuries, improvements in transparency and citation accuracy are still needed before these tools can be fully trusted as medical information sources.

Ream-and-run (RnR) arthroplasty is a shoulder replacement technique used for patients with glenohumeral arthritis who want to avoid the limitations of a traditional prosthetic socket, but a key concern is ongoing wearing away of the shoulder socket bone over time. Since the bacterium *Cutibacterium* is commonly found during revision shoulder surgeries and has been linked to bone breakdown, researchers investigated whether its presence might explain this bone loss. In this study, 39 patients who underwent revision surgery after an RnR procedure were evaluated using semi-quantitative bacterial cultures and shoulder X-rays to measure glenoid bone medialization — the degree to which the socket moved inward over time. Results showed that 64% of patients tested positive for *Cutibacterium*, yet both culture-positive and culture-negative groups experienced nearly identical rates of bone loss (approximately 1.3–1.4 mm per year), with no statistically significant relationship between bacterial load and bone wear. These findings suggest that *Cutibacterium* is unlikely to be a major driver of glenoid medialization after RnR arthroplasty, though the authors note that longer follow-up studies are needed to more fully understand what causes this bone loss.

This study examined how much the shoulder socket (glenoid) wears down over time in patients who underwent a type of shoulder replacement called ream-and-run arthroplasty, where a metal ball is used but the socket is not replaced with an artificial component. Researchers analyzed X-rays from 113 shoulders over an average of 6.7 years, measuring how much the humeral head shifted inward as an indicator of bone wear. The majority of patients (81%) experienced minimal or mild wear, with an overall wear rate of about 0.3 mm per year, though most wearing occurred within the first four years and then leveled off rather than progressing steadily. Younger patients and those without prior shoulder surgery were more likely to experience moderate or severe wear, and those with greater wear had higher rates of needing revision surgery, though pain and functional outcomes were similar across wear categories. These findings suggest that ream-and-run arthroplasty produces generally acceptable levels of glenoid wear over the medium term, and that bone loss tends to stabilize rather than continue indefinitely, which is reassuring for younger, active patients considering this procedure.

Reverse shoulder arthroplasty (rTSA) is a type of shoulder replacement surgery, and while baseplate failure—where the metal base attached to the shoulder blade loosens or breaks—is uncommon, it can lead to serious complications requiring additional surgery. This large multicenter study analyzed 5,049 rTSA cases across 15 U.S. institutions to identify patient and surgical factors that increase the risk of baseplate failure. Researchers found that 83 patients (1.6%) experienced baseplate failure, most of which occurred without a traumatic injury, suggesting that poor bone integration was a primary cause. Key risk factors included revision surgery (redoing a prior shoulder replacement), the use of bone grafts—particularly donor bone from another person (allograft) rather than the patient's own bone (autograft)—and greater lateral positioning of the implant on the shoulder blade. Importantly, using a central screw for fixation appeared to reduce the risk of failure, and these findings can help surgeons make more informed decisions about implant design and surgical technique to improve patient outcomes.

This study examined whether insurance-required physical therapy (PT) before shoulder replacement surgery was effective or necessary for patients with moderate to severe glenohumeral osteoarthritis (GHOA), a degenerative condition causing significant shoulder pain and loss of motion. Researchers followed 12 patients who were initially denied shoulder arthroplasty by their insurance carriers because they had not completed preoperative PT, tracking outcomes including pain levels, range of motion, and whether surgery was ultimately performed. Of the 7 patients required to complete PT before surgery, 6 still went on to have shoulder replacement, and PT did not meaningfully improve pain or joint function in any of the patients. Additionally, a provider survey revealed that nearly half of healthcare providers spend 40–60 minutes on peer-to-peer insurance appeals, highlighting the administrative burden imposed by these denials. These findings suggest that insurance-mandated PT prior to shoulder arthroplasty lacks clinical justification for advanced GHOA and creates unnecessary delays and burdens for both patients and providers.

This study investigated whether the angle at which the glenoid component (the socket-side implant) is positioned during anatomic total shoulder arthroplasty affects patient outcomes. Surgeons have traditionally aimed for less than 15 degrees of retroversion during implant placement, but the clinical importance of this threshold has not been well established. Researchers conducted a systematic review and meta-analysis of 15 studies involving 1,190 shoulder replacements, comparing outcomes between patients with less than 15 degrees and 15 degrees or more of glenoid retroversion. No clinically meaningful differences were found between the two groups in patient-reported outcomes, range of motion, or complication rates. These findings suggest that moderate deviations from the commonly accepted 15-degree threshold may not significantly harm short-term clinical results, though longer follow-up studies are needed to fully understand the impact of glenoid positioning on implant longevity and overall outcomes.

This systematic review examined which surgical approach leads to better outcomes in total elbow arthroplasty (TEA), a procedure used to treat severe elbow arthritis when non-surgical treatments have failed. Researchers analyzed 25 studies published between 2004 and 2024 across major medical databases, comparing two techniques: the triceps-splitting approach, which cuts through the triceps muscle, and the triceps-reflecting approach, which peels the muscle back without cutting it. Across 2,393 elbow surgeries, both approaches improved patients' elbow function and range of motion, but the triceps-reflecting group showed a larger improvement in Mayo Elbow Performance Scores and more favorable gains in joint mobility. Notably, the complication rate was substantially higher in the triceps-splitting group (31.2%) compared to the triceps-reflecting group (17.7%), suggesting a meaningful safety advantage for the reflecting technique. These findings indicate that the triceps-reflecting approach may be the preferable surgical option for TEA, though the authors emphasize the need for higher-quality, standardized studies to draw firmer conclusions.