Total shoulder arthroplasty (TSA) is a successful treatment method for patients with end-stage glenohumeral osteoarthritis and different factors influencing the clinical outcome have been determined. However, the role of hand dominance on the postoperative clinical results and implant survival is not well analyzed. Hypothesis: Hand Dominance does not influence the outcome after TSA. In this single center cohort study, 138 consecutive patients with primary Osteoarthritis (OA)were treated with a TSA and evaluated with a mean follow-up of 45 months (range 24-158 months). 62.32 % (86 patients) underwent TSA on the dominant side (DOM group) and 37.68 % (52 patients) on their non-dominant side (NON-DOM group). For clinical evaluation the adjusted Constant-Murley (CS) score, pain (Numeric analog scale (NAS)), subjective satisfaction and range of motion (ROM) were recorded. Furthermore, survivorship analysis was performed for the endpoint revision for any reason. Both dominant (DOM) and non-dominant (NON-DOM) groups demonstrated significant improvement in all clinical outcomes from pre-to postoperative (p < 0.0001) with no between-group differences (p > 0.05). Implant survival was 98.8 % at 123 months (DOM) and 90 % at 158 months (NON-DOM) (p = 0.89). Hand dominance did not influence postoperative outcomes, survivorship, or age at time of surgery. Patients can expect excellent results after TSA regardless of their predominant dexterity. Retrospective cohort study, Level III.
1 June 2012 in Clinical Orthopaedics and Related Research
Treatment of Early Postoperative Infections after THA: A Decision Analysis'', featuring the authors' decision tree and analysis model addressing the treatment of patients presenting with postoperative infections during the first 3 weeks after cementless primary THA [1]. This model estimates the rate of infection control and quality-of-life values after a specific treatment in terms of possible outcomes for each treatment. The study compared the results of one-stage and two-stage exchanges, taking into consideration the variety of published data on infection control for individual treatments [1]. Control of prosthetic joint infections (PJI) is the major criterion for a patientoriented decision model. The studies analyzed for this decision model do not consider the related risk factors. The authors' work is ''based on the best literature currently available,'' but the authors overlooked studies that use a staging system such as that of McPherson et al. [3] or of
Reducing perioperative risk is in the focus of primary arthroplasty caregivers. Primary shoulder arthroplasty patients are considered among those with the lowest perioperative risk. Nonetheless, in tertiary care centres and university settings patients with significant comorbidities are being treated. It remains unclear whether the overall comorbidity burden is truly higher and if this results in an increased frequency of adverse events (AE). As a result, we conducted a study to assess the comorbidity burden and the frequency of major perioperative adverse events and predictive factors following primary shoulder arthroplasty in the university setting. A retrospective cohort analysis was conducted on patients undergoing primary shoulder arthroplasty for a non-trauma, non-tumour indication from January 1st, 2014 through December 31st, 2018. Administrative data were recorded to assess comorbidity burden and revision surgery within the first postoperative year. Major adverse events were routinely recorded on a weekly basis by the treating physicians. Descriptive and comparative statistical analyses were performed. The cohort was compared against a large North American sample. Of 386 patients who underwent 400 primary shoulder arthroplasties 14 (3.5 %) experienced adverse events. While AE were distributed equally among anatomical and reverse shoulder arthroplasties, no adverse event was recorded in the 34 hemiarthroplasty patients. The cohort showed an increased comorbidity burden in international comparison. Peptic ulcer disease was significantly associated with AE, while mild liver disease experienced a trend towards AE. We found an increased comorbidity burden and a low rate of AE for primary shoulder arthroplasty in a tertiary care and university setting. The distinct role of peptic ulcer disease in this cohort and the trend in mild liver disease merit further investigation in larger samples. The findings underscore the importance of perioperative risk assessment and management. III, retrospective cohort study.