Shoulder and Elbow Recent Publications

This study describes a surgical technique for repairing a lesser tuberosity osteotomy (LTO), a cut made in the upper arm bone during total shoulder replacement surgery to access the shoulder joint. Proper healing of this bone cut is essential for good surgical outcomes, so the researchers developed a method using a specific suture (stitching) system to hold the bone fragment securely in place. The technique combines two rows of strong sutures — one passed through small bone tunnels and another threaded through the metal shoulder implant itself — which are then tied together and manually tightened to create compression and stability at the repair site. This approach is designed to be straightforward and consistent across different patients, making it easier for surgeons to reliably reproduce the same quality of repair. By improving stability and compression at the osteotomy site, this technique has the potential to promote better bone healing and ultimately improve patient outcomes following anatomic total shoulder replacement surgery.

This study examined whether patients with shoulder arthritis who have uneven (posteriorly eccentric) joint wear patterns have different outcomes after total shoulder replacement compared to patients with more uniform (concentric) wear, when surgeons use a conservative bone-shaping technique without correcting the angle of the shoulder socket. Researchers reviewed 210 patients from an institutional registry who had at least five years of follow-up after surgery, assessing shoulder function using the Simple Shoulder Test, X-ray findings, and rates of complications or repeat surgeries. At an average follow-up of eight years, functional outcomes were similarly strong across both groups, regardless of wear pattern, socket alignment, or glenoid version after surgery. Although 29% of patients with long-term X-rays showed lines around the implanted socket component (radiolucencies), these findings did not lead to worse clinical outcomes, and incomplete seating of the implant was the strongest predictor of their development. These results suggest that conservative surgical techniques without version correction are a viable and durable approach for a wide range of shoulder arthritis patients, including those with more complex wear patterns.

This randomized controlled trial investigated whether adding hydrogen peroxide (H₂O₂) to chlorhexidine gluconate (CHG) improves the removal of *Cutibacterium* — the bacteria most responsible for shoulder joint infections after prosthetic surgery — from the skin surface. Eighteen male volunteers had one shoulder treated with CHG alone and the other with H₂O₂ followed by CHG, with skin swabs collected before preparation and 60 minutes after. Both preparations significantly reduced *Cutibacterium* levels immediately after application, but by the 60-minute mark, bacteria had repopulated the skin surface in 78% of shoulders in both groups, with no statistically significant difference between treatments. These findings indicate that adding hydrogen peroxide provides no meaningful advantage over CHG alone in eliminating *Cutibacterium*, likely because the bacteria shelter deep within sebaceous glands beyond the reach of topical antiseptics. The results highlight an ongoing challenge in preventing shoulder periprosthetic joint infections and suggest that new strategies targeting bacteria within the skin's deeper layers may be necessary.

Proximal humerus fractures sometimes fail to heal properly, leading to painful malunions or nonunions that significantly impair shoulder function. When bone quality is too poor or arthritis is present to allow for joint-preserving surgery, shoulder replacement becomes the preferred treatment option. Reverse shoulder arthroplasty (RSA), a type of joint replacement with a specialized design that does not rely on intact rotator cuff muscles, has proven particularly effective in these complex cases involving bone deformity or tendon damage. Clinical studies show consistently reliable outcomes with RSA, and an existing classification system helps surgeons predict complications and patient prognosis. This review highlights that with careful surgical technique—especially in managing the bony attachments around the shoulder—RSA serves as a powerful solution for patients suffering from the long-term consequences of proximal humerus fractures.

This study examined how hamstring strain injuries affect the athletic performance of NCAA Division I college football players, looking beyond simply whether athletes returned to the field. Researchers tracked 44 players who sustained 58 hamstring injuries over four years, using GPS and motion-tracking devices to measure speed, acceleration, and workload during practices and games before and after injury. Although all 25 players with complete tracking data were able to return to play in an average of about nine days, most failed to fully recover their pre-injury performance levels even after more than a year of follow-up. Only four players regained their pre-injury benchmarks across all four performance metrics, and just eight players returned to their prior ability to sustain high-speed running above 12 mph. These findings suggest that the standard measure of "return to play" may significantly underestimate the true impact of hamstring injuries on elite athletes, highlighting the need for improved rehabilitation strategies and more comprehensive recovery benchmarks.

This study investigated whether leaving behind cement or metal hardware during the first stage of a two-stage shoulder joint replacement revision surgery increases the risk of recurring infection. Researchers retrospectively reviewed 37 patients who underwent two-stage revision shoulder arthroplasty for prosthetic joint infection at two institutions between 2011 and 2020, with at least two years of follow-up after the procedure was completed. Of the 37 patients, seven had retained cement or hardware after the first surgical stage, and 10 patients total experienced a recurrent infection — only one of whom had retained material. Statistical analysis showed no significant association between retained cement or hardware and the risk of repeat infection, even after accounting for factors like age, BMI, diabetes, and other health conditions. These findings suggest that surgeons may reasonably choose to leave behind difficult-to-remove cement or hardware when complete removal would significantly increase surgical risk or damage bone needed for stable implant placement.

Severe bone loss on the socket side of the shoulder joint (glenoid medialization) makes standard shoulder replacement surgery risky because there may not be enough bone to securely anchor the socket component. This study examined outcomes for patients who underwent shoulder hemiarthroplasty — a procedure that replaces only the ball portion of the joint, leaving the damaged socket alone — as an alternative when a full replacement was not feasible. Researchers reviewed records and surveyed 11 patients (average age 71 years) who had this procedure between 2010 and 2020, collecting functional outcome scores and analyzing pre- and post-operative X-rays over an average follow-up of nearly 7 years. Patients reported modest but meaningful improvements in shoulder function, with no reoperations or implant failures observed, though two patients showed early signs of the humeral implant shifting slightly out of position. These findings suggest that hemiarthroplasty is a reasonable surgical option for patients with severe glenoid bone loss who are at high risk for complications with a standard total shoulder replacement, offering acceptable mid- to long-term outcomes with a low rate of serious complications.

This study examined outcomes in patients who underwent total shoulder arthroplasty (TSA), a surgical procedure to replace the shoulder joint, with the goal of identifying which patients were most likely to achieve excellent functional results at least five years after surgery. Researchers collected pre-operative data and follow-up shoulder function scores from 188 patients, using the Simple Shoulder Test (SST) to measure outcomes, and defined "excellent" results as a final SST score of 10 or higher and meaningful improvement relative to the best possible score. On average, patients showed significant improvement in shoulder function after surgery, and 95% of patients surpassed the threshold for a minimally important clinical difference. However, male sex and having commercial insurance were independently associated with achieving excellent outcomes, while patients covered by Workers' Compensation insurance were significantly less likely to reach those higher benchmarks. These findings suggest that factors beyond surgical technique — including sex and insurance type — play an important role in recovery, and the identified outcome thresholds may help surgeons better counsel patients about expected results before undergoing TSA.

This study examined outcomes of two-stage revision surgery—a common procedure where an infected elbow implant is removed, infection is treated, and a new implant is later inserted—in patients with infected total elbow replacements at a single institution between 2006 and 2020. Researchers reviewed records from 19 patients, collecting data on surgical details, bone loss, cement removal, component retention, and infection recurrence. Nearly half of the patients (47%) experienced a recurrent infection after completing the two-stage revision process, highlighting a strikingly high failure rate compared to similar procedures in the hip and knee. While retaining cement or implant components during the first stage did not statistically increase the risk of reinfection, it was strongly associated with reduced need for bone grafting during the second stage, suggesting that aggressive removal of well-fixed hardware may cause unnecessary bone damage without clearly improving infection control. These findings suggest that surgeons should carefully weigh the risks of removing well-fixed components and cement, as doing so may compromise bone structure and complicate reconstruction without providing a definitive benefit in eliminating infection.

This study investigated what factors increase the risk of developing problematic joint stiffness after ream-and-run arthroplasty, a type of shoulder replacement surgery that resurfaces the socket without implanting an artificial glenoid component. Researchers reviewed records from 340 patients who had undergone this procedure, tracking which patients later required additional interventions — either manipulation under anesthesia or open surgical revision — to treat postoperative stiffness. Overall, shoulder function improved significantly for most patients, but about 18% required a repeat procedure for stiffness. Statistical analysis identified three independent risk factors: younger age, being classified as relatively healthy (ASA class 1 versus class 3), and having limited passive forward shoulder elevation at the time of hospital discharge. Notably, nearly 70% of patients who needed open revision for stiffness tested positive for Cutibacterium, a slow-growing bacterium commonly found on skin, suggesting that low-grade infection may contribute to stiffness in some cases and highlighting the importance of early monitoring and targeted rehabilitation for higher-risk patients after this procedure.