Reverse total shoulder arthroplasty (RTSA) is the standard of care for patients with glenohumeral osteoarthritis and rotator cuff deficiency. Preoperative RTSA planning based on medical images and patient-specific instruments has been established over the last decade. This study aims to determine the effects of using augmented reality-assisted intraoperative navigation (ARIN) for baseplate positioning in RTSA compared to preoperative planning. It is hypothesized that ARIN will decrease deviation between preoperative planning and postoperative baseplate positioning. Moreover, ARIN will decrease deviation between the (senior) more (>50 RTSAs/yr) and less experienced (junior) surgeon (5-10 RTSAs/yr). Preoperative CT scans of 16 fresh-frozen cadaveric shoulders were obtained. Baseplate placements were planned using a validated software. The data were then converted and uploaded to the augmented reality system (NextAR; Medacta International). Each of the 8 RTSAs were implanted by a senior and a junior surgeon, with 4 RTSAs using ARIN and 4 without. A postoperative CT scan was performed in all cases. The scanned scapulae were segmented, and the preoperative scan was laid over the postoperative scapula by the nearest iterative point cloud analysis. The deviation from the planned entry point and trajectory was calculated regarding the inclination, retroversion, medialization (reaming depth) and lateralization, anteroposterior position, and superoinferior position of the baseplate. Data are reported as mean ± standard deviation (SD) or mean and 95% confidence interval (CI). P values < .05 were considered statistically significant. The use of ARIN yielded a reduction in the absolute difference between planned and obtained inclination from 9° (SD: 4°) to 3° (SD: 2°) (P = .011). Mean difference in planned-obtained inclination between surgeons was 3° in free-hand surgeries (95% CI: -4 to 10; P = .578), whereas this difference reduced to 1° (95% CI: -6 to 7, P = .996) using ARIN. Retroversion, medialization (reaming depth) and lateralization, anteroposterior position, and superoinferior position of the baseplate were not affected by using ARIN. Surgical duration was increased using ARIN for both the senior (10 minutes) and junior (18 minutes) surgeon. The implementation of ARIN leads to greater accuracy of glenoid component placement, specifically with respect to inclination. Further studies have to verify if this increased accuracy is clinically important. Furthermore, ARIN allows less experienced surgeons to achieve a similar level of accuracy in component placement comparable to more experienced surgeons. However, the potential advantages of ARIN in RTSA are counterbalanced by an increase in operative time.

Posterior shoulder dislocation frequently results in a centrally located impression fracture of the anterior humeral head, known as reverse Hill-Sachs lesion (RHSL). Depending on size and location of RHSL the RHSL can lead to engagement with the posterior glenoid rim and subsequently re-dislocation of the shoulder joint. The objective of this study was to present the clinical and radiological outcomes of anatomical reconstruction of the humeral articular surface using arthroscopically assisted disimpaction in patients with acute posterior shoulder dislocation and an engaging RHSL. As part of a retrospective analysis, nine shoulders in nine patients (1 female, 8 males) with engaging RHSL following acute posterior shoulder dislocation (Type A2 according to the ABC classification) who underwent arthroscopically assisted disimpaction of the RHSL between 2016 and 2023 were identified. Eight patients were included, as one patient refused to participate. In all patients a radiological analysis of the RHSL was accomplished on preoperative and postoperative cross-sectional imaging including alpha, beta and gamma angle as well as depth measurements. The clinical examination included an assessment of active range of motion, instability tests, and patient-reported outcome measures (PROMs), such as the Western Ontario Shoulder Instability (WOSI) Index, the Constant Score (CS), and the Subjective Shoulder Value (SSV). The mean follow-up period for all eight patients was 34.4 ± 38 months (range: 6-102 months). The mechanisms of injury included falls (n=6), traffic accident (n=1), and convulsive episode (n=1). The average time from injury to surgery was 6.8 ± 4.7 days (range: 2-16). Patient-reported outcomes at the final follow-up indicated an average WOSI Index of 77.8 ± 17 %, a mean Constant Score of 88.3 ± 11 points, and a mean Subjective Shoulder Value (SSV) of 87 ± 16 %. None of the patients experienced recurrent dislocations during the follow-up period. Post-traumatically, the mean absolute defect depth was 8.4 ± 2.2 mm and mean gamma angle was 115.8 ± 13 °. In the radiological follow-up, the RHSL depth measurements showed a significant reduction in the mean defect depth from 8.4 ± 2 mm to 1.2 ± 1 mm resulting in an average reduction of the RHSL by 7.1 mm (p<0.001). In three of the eight patients (37.5%) the RHSL was not identifiable anymore at follow-up and in 5 patients barely identifiable. Arthroscopically assisted disimpaction of acute RHSLs leads to close to anatomic reduction of RHSL, achieving a stable shoulder and good clinical outcomes. Level IV; Case Series; Treatment Study.

Various surgical approaches and fixation methods are available for distal biceps tendon repair. Although all-suture anchors offer theoretical advantages and are widely used in orthopedic surgery, clinical data on their use in distal biceps tendon repairs remain limited. This study aims to evaluate the clinical and functional outcomes of distal biceps tendon repair using two all-suture anchors via a single-incision approach. We hypothesized that this technique would result in effective restoration of supination strength, excellent patient-reported outcomes, and a low rerupture rate. A retrospective analysis was conducted on patients who underwent distal biceps tendon repair using all-suture anchors between September 2016 and September 2022. A total of 40 patients were included. At clinical follow-up, range of motion, elbow flexion, and forearm supination strength were measured and compared to the contralateral side. Subjective outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand questionnaire, Subjective Elbow Value, Mayo Elbow Performance Score, American Shoulder and Elbow Surgeons Standardized Elbow Assessment Questionnaire, and visual analog scale for pain. Complications were recorded. The mean age at the time of injury was 51.9 ± 9.2 years. The mean follow-up duration was 4.8 ± 2 years, and the mean time between injury and surgery was 14.2 ± 11.9 days. Median Disabilities of the Arm, Shoulder and Hand, Subjective Elbow Value, Mayo Elbow Performance Score, and American Shoulder and Elbow Surgeons Standardized Elbow Assessment Questionnaire scores were 2.3 (range, 0-31.8), 100 (range, 50-100), 100 (range, 70-100), and 98 (range, 53-100), respectively. The median pain level on the visual analog scale was 0 (range, 0-7), with only one patient reporting pain at rest. Mean relative elbow flexion strength compared to the uninjured side was 99.5 ± 23.3%, and forearm supination strength was 88.7 ± 28.2%. The rerupture rate was 2.5%, with 1 case occurring within the first postoperative week. All patients returned to work after an average of 8.7 ± 8.4 weeks, and 96.9% (31/32) returned to sports, with 81.3% (26/32) returning to >90% of their preinjury activity level. Our findings demonstrate that distal biceps tendon repair using two all-suture anchors via a single-incision approach yields excellent patient-reported outcomes. With a low rerupture rate as well as high return-to-work and return-to-sport rates, this technique appears to be a reliable treatment option. However, the observed reduction of forearm supination strength underscores the need for further research to optimize anatomical footprint coverage.

Aims: Augmented reality–assisted intraoperative navigation (ARIN) has recently emerged as a novel technology intended to improve intraoperative accuracy and workflow in reverse shoulder arthroplasty (RSA). This study evaluated the impact of ARIN on early complications and revisions, glenoid baseplate inclination and fixation, fluoroscopy time, and surgical duration. Methods: Two hundred three primary RSAs were retrospectively analyzed: 72 performed with ARIN and 131 freehand. The primary outcome was 90-day complications and revisions. Secondary outcomes were baseplate inclination (RSA angle on true AP radiographs), number and length of peripheral screws, fluoroscopy time, and surgical duration. Results: No statistically significant differences were observed between the ARIN and freehand groups regarding complications (3% vs. 9.4%, p = .139), revisions (3% vs. 8.5%, p = .216), or dislocations (1.5% vs. 3.4%, p = .655). Baseplate inclination was significantly closer to neutral in the ARIN group (4.6° ± 7° vs. 11.6° ± 8.1°, p < .001), and superior inclination > 10° was significantly less frequent (18.8% vs. 55.6%, p < .001). Significantly fewer screws were used for baseplate fixation (2.1 ± 0.4 vs. 3.2 ± 0.9, p < .001), which were significantly longer (33.7 ± 6.3 mm vs. 25.6 ± 7.8 mm, p < .001). Fluoroscopy time (19.7 ± 15.4 s vs. 45.9 ± 37.1 s, p < .001) and operative duration (104.1 ± 27.3 min vs. 113.4 ± 35.3 min, p = .038) were also significantly shorter with ARIN. Conclusion: ARIN in RSA was associated with improvements in glenoid baseplate inclination, screw placement, intraoperative fluoroscopy time, and surgical duration, while no statistically significant differences in early complication, dislocation, or revision rates were observed compared with the conventional freehand technique. Larger studies with greater statistical power and longer follow-up are warranted to determine potential long-term clinical benefits. Evidence level and study design: Level of evidence III; retrospective comparative study.

Background/Objectives: Periprosthetic joint infection (PJI) after shoulder arthroplasty is often treated with a two-stage approach, but the data on the mid- to long-term outcomes remain scarce. This study aimed to evaluate the clinical outcomes of two-stage revision arthroplasty for shoulder PJI with a minimum follow-up of five years. Methods: This retrospective study identified 59 shoulders in 58 patients who underwent the first stage of a two-stage revision arthroplasty for shoulder PJI at our institution between 2007 and 2018. Of these, 29 shoulders in 29 patients (49.2%) did not undergo reimplantation or the patient passed away before reaching five years of follow-up. The remaining 30 shoulders in 29 patients were included in the study. The clinical assessments included the active range of motion, the visual analogue scale (VAS) for pain, the Subjective Shoulder Value (SSV), the Constant Score (CS), and the 12-Item Short Form Survey (SF-12), supplemented by detailed clinical and radiological evaluations. Results: The mean age of the 29 patients was 75.9 ± 10.4 years. The average follow-up duration was 8.3 ± 2.8 years. The most common indications for primary shoulder arthroplasty were primary osteoarthritis (n = 12, 40%) and fractures (n = 12, 40%). At the first stage, nine cases (30%) showed negative cultures, while C. acnes and S. epidermidis were each identified in eight cases (26.7%). Four shoulders (13.3%) experienced recurrent infections. At the follow-up, the mean abduction was 86 ± 48.1°, the mean forward flexion was 97.8 ± 50.1°, the mean external rotation was 20.5 ± 19.9°, and the internal rotation reached the lumbosacral region. The mean VAS pain score was 1.5 ± 2.1, the mean SSV was 51.8 ± 28.4%, the mean CS was 54.6 ± 21.0, and the mean SF-12 was 81.0 ± 16.0. Conclusions: Two-stage revision arthroplasty for shoulder PJI results in satisfactory subjective and objective outcomes, with a low overall reinfection rate. However, the high rates of mortality and failure to reimplant must be carefully considered when managing expectations in this challenging cohort.