The mechanisms of glenoid component loosening in anatomic total shoulder arthroplasty (aTSA) are still unclear, and it remains undetermined which specific radiographic features are associated with clinical outcomes. Patients with primary osteoarthritis who underwent aTSA with a stemless implant and a pegged glenoid between January 2011 and December 2016 were extracted from a local registry. Anteroposterior radiographs were evaluated at six, 12, 24 months, and five years post-TSA for lateral humeral offset (LHO), joint gap (JG), acromiohumeral distance (AHD), and radiolucency (modified Franklin score); 147 patients were included. Mixed-model linear regression was used. Both constant score (CS) and subjective shoulder value (SSV) markedly decreased at five years follow-up compared to one year (p < 0.001 for both). AHD, LHO, and JG all showed a consistent and statistically significant decline over time, with the joint gap decreasing by half. Consistently, smaller JG and AHD were correlated with lower SSV (p = 0.03 and p = 0.07, respectively). Massive loosening was associated with a 14.5 points lower SSV (p < 0.01). Finally, narrowing of the JG was significantly correlated with increased radiolucency (p < 0.001) and tended toward worse SSV (p = 0.06). In summary, radiographic parameters displaying medialization and cranialization after aTSA with a cemented pegged glenoid are useful predictors of impaired shoulder function.

There is a lack of consensus on what physicians can recommend and what patients can expect concerning sports activity after reverse shoulder arthroplasty (RSA). The purpose of this retrospective register-based observational study was to investigate the association between participation in sports or physical activity involving the upper extremity and 5-year clinical and radiological outcomes for primary RSA patients. We screened the institutional arthroplasty registry for patients reporting the type and level of sports postoperatively after primary, unilateral RSA due to rotator cuff deficiency. One hundred thirty-eight patients with clinical and radiological outcomes documented at a minimum 5-year follow-up were divided into three groups comprising those who participated regularly in: sports mainly involving the upper extremity (sports upper extremities, SUE, n = 49), sports mainly involving the lower extremities (sports lower extremities, SLE, n = 21), and those who did not participate in sports at all (no sports, NS, n = 68). The participants had a mean age of 72 years (standard deviation (SD) 8) and were overall predominantly female patients (62%). Primary clinical outcomes included the Constant Score (CS) and Shoulder Pain and Disability Index (SPADI). Secondary radiographs were analyzed for radiolucent lines (RLL), signs of glenoid or humeral prosthesis loosening, bone resorption, bone formation, and scapular notching. A total number of 8 senior surgeons were involved in treatment of patients, and two types of prosthesis were used. The SUE group had non-significantly higher mean scores for CS (75 points) and SPADI (88 points) compared to SLE (71 and 78 points, respectively) and NS patients (66 and 78 points, respectively) (p ≥ 0.286). The incidence of RLL around the humeral diaphysis was higher in NS compared to SUE patients (32% versus 12%, respectively) (p = 0.025); all other radiological parameters were similar between the groups. There were no cases of loosening in the SUE group that led to revision surgery. Patients engaging in sports activities involving the upper extremity show similarly good functional scores 5 years post-RSA as the other groups, without additional signs of implant loosening as a result of increased shoulder use.

Study design: Retrospective data analysis. Objectives: This study aims to develop a deep learning model for the automatic calculation of some important spine parameters from lateral cervical radiographs. Methods: We collected two datasets from two different institutions. The first dataset of 1498 images was used to train and optimize the model to find the best hyperparameters while the second dataset of 79 images was used as an external validation set to evaluate the robustness and generalizability of our model. The performance of the model was assessed by calculating the median absolute errors between the model prediction and the ground truth for the following parameters: T1 slope, C7 slope, C2-C7 angle, C2-C6 angle, Sagittal Vertical Axis (SVA), C0-C2, Redlund-Johnell distance (RJD), the cranial tilting (CT) and the craniocervical angle (CCA). Results: Regarding the angles, we found median errors of 1.66° (SD 2.46°), 1.56° (1.95°), 2.46° (SD 2.55), 1.85° (SD 3.93°), 1.25° (SD 1.83°), .29° (SD .31°) and .67° (SD .77°) for T1 slope, C7 slope, C2-C7, C2-C6, C0-C2, CT, and CCA respectively. As concerns the distances, we found median errors of .55 mm (SD .47 mm) and .47 mm (.62 mm) for SVA and RJD respectively. Conclusions: In this work, we developed a model that was able to accurately predict cervical spine parameters from lateral cervical radiographs. In particular, the performances on the external validation set demonstrate the robustness and the high degree of generalizability of our model on images acquired in a different institution.

Introduction Magnet Resonance Imaging (MRI) is essential for neurocritical care but requires intrahospital transport (IHT) in patients treated in an intensive care unit, which carries significant risks. This study assesses the risk profile and whether the benefits of MRI in aneurysmal subarachnoid hemorrhage (aSAH) outweigh the associated complications of IHT. Method In this retrospective study, all aSAH patients treated in our neurocritical care unit (NCCU) between 2016 and 2023 were screened. Data collection included baseline demographics, hemorrhage severity scores, aneurysm treatment strategies, additional neurosurgical procedures, and need for spasmolysis. IHT- and MRI-related variables were recorded, including timing, indication, duration, and associated physiological parameters such as blood gas values, vital signs, intracranial pressure (ICP), and cerebral perfusion pressure (CPP). The incidence of complications and the clinical impact of MRI findings were evaluated. Statistical comparisons were conducted using the Wilcoxon signed-rank test. Results Of 337 screened patients, 115 (34.1%) patients with aSAH underwent a MRI during the NCCU stay and were included in the analysis, with a total of 156 MRI scans performed. The most common reason for a MRI was ischemia exclusion (61%). Complications occurred in 16% of patients ( n = 25), classified as systemic (56%), cerebral (37%), and technical (7%). Blood gas analysis showed no significant changes before and after IHT. In the subgroup of patients with an external ventricular drain (EVD) in situ ( n = 93), ICP remained stable, while CPP increased from 85.4 (± 20.5) to 92.1 (± 19.9) mmHg ( p = 0.009). Accordingly, systolic BP and MAP increased ( p = 0.019 and < 0.001, respectively) and HR decreased by 4/min ( p < 0.001). Conclusion We found lower frequency of IHT-related complication in brain MRI after aSAH compared to existing literature reflecting a well-established and safe clinical process. Moreover, MRI findings had a notable impact on key therapeutic decisions, supporting the use of MRI-based IHT in selected cases, provided that a thorough risk-benefit assessment is conducted.

Surgical site infections (SSI) constitute a source of morbidity in neurosurgical patients. Few reports address incidence of SSIs in patients undergoing craniotomy for neurovascular diseases. This study aims to determine incidence and characteristics of SSI with interval to diagnosis, severity, and type of pathogen after intracranial neurovascular surgery. Data from consecutive patients undergoing intracranial neurovascular surgery between January 2013 and 2022 were retrospectively analyzed in our tertiary referral center. Demographic data, risk factors, treatment and hospital stay were collected. Impact of SSI were classified according to Clavien Dindo Grade (CDG). Parameters studied included the time from index to revision surgery, microorganisms involved, and underlying pathology for the index surgery. Among 1065 neurovascular surgeries, SSI occurred in 34 cases (2.1 %, n = 19 males). Median patient's age was 53 years (interquartile range, IQR 45-60). The median time from the index procedure to surgical wound revision was 27.5 days (IQR 19-44). The median length of hospital stay after revision surgery was 7 days (IQR 4-15). The predominant pathogen was Staphylococcus epidermidis (11, 32 %), followed by Staphylococcus aureus (8, 22 %). In 32 cases (89 %) wound revision was performed under general anesthesia. The overall incidence of SSI in our center was 2.1 % with a mean time to wound revision of 29 days. These numbers can be used as a benchmark and reference for strategies that implement a reduction of postoperative infections in neurovascular surgery.