Background/Objectives: Reverse total shoulder arthroplasty (RTSA) is increasingly common, but large-scale studies on age-related differences in outcomes are limited. This study aims to evaluate epidemiological trends, clinical indications, and postoperative outcomes in patients under 65 undergoing RTSA. Methods: We analyzed data from the Nationwide Inpatient Sample (NIS) from 2016–2021, including 48,460 patients aged 35–64 undergoing shoulder arthroplasty. Patients were stratified into three age groups: 35–45, 46–55, and 56–65 years. We assessed trends, clinical indications, comorbidities, hospital stay metrics, and postoperative complications using chi-square tests, ANOVA, and multivariate logistic regression. Results: Procedure volumes increased from 2016 to 2019, peaking at 2007 cases, but declined in 2020 and 2021 (924 cases). The 56–65 age group consistently comprised the majority of procedures (81.7% in 2016 to 88.3% in 2021). Comorbidities like type 2 diabetes (5.9% to 22.8%), hypertension (27.9% to 55.3%), and dyslipidemia (10.3% to 40.5%) increased with age (p < 0.001). Rotator cuff tears were more prevalent in older patients (25% to 48.5%, p < 0.001), while instability was higher in the youngest group (8.8%, p < 0.001). Osteoarthritis was the most common indication, increasing with age (56.6% to 62.5%, p < 0.001). Cardiac complications increased with age (2.2% to 5.1%, p = 0.04). Female gender (OR = 1.548, p < 0.001), private insurance (OR = 1.570, p < 0.001), and small hospital size were associated with higher odds of cardiac complications. Native American race showed lower odds (OR = 0.308, p = 0.009) compared to White patients. Conclusions: Significant age-related differences exist in comorbidities, clinical indications, and postoperative complications following RTSA. Older patients had higher rates of comorbidities and cardiac complications, while younger patients presented with instability. These findings highlight the importance of age-specific perioperative management to optimize outcomes.

Background/Objectives: Chronic low back pain (CLBP) affects approximately 20% of the global population. While cannabis-based therapies have shown short-term analgesic potential, long-term evidence remains scarce. This study assessed the four-year efficacy of inhaled cannabis therapy on pain and disability outcomes, while exploring BioWell gas discharge visualization (GDV) parameters as non-invasive biomarkers. Methods: In this prospective observational study (IRB 0634-25-RMC and 807-21-RMC), 241 adults with CLBP (mean age 49.3 ± 14.9 years; 62.2% male) who had failed ≥1 year of conventional therapy initiated inhaled cannabis (predominantly smoking, 91%). Cannabis contained THC (4–22%) and CBD (2–22%), with dosing titrated from 21.5 g/month (Year 1) to 56.7 g/month (Year 4). Primary outcomes—NRS, ODI, BPI severity and interference—and secondary BioWell stress and vitality were assessed annually. Analyses included repeated-measures ANOVA, mixed-effects models, ROC analysis, network analysis, K-means clustering, and survival analysis. Results: Of 241 enrolled patients, 229 (95.0%) completed Year 4 follow-up. NRS decreased from 8.08 ± 1.61 to 2.71 ± 1.46 (p < 0.001), ODI from 55.05 ± 15.90 to 36.82 ± 8.47 (p < 0.001), BPI severity from 7.94 ± 1.71 to 1.11 ± 0.53 (p < 0.001), and BPI interference from 5.84 ± 2.02 to 2.20 ± 1.69 (p < 0.001). BioWell stress discriminated moderate-to-severe pain (NRS > 4) with AUC 0.71 (95% CI 0.65–0.77). Fibromyalgia at baseline predicted discontinuation (HR 1.59, 95% CI 1.18–2.14, p = 0.003). Conclusions: Inhaled cannabis therapy was associated with sustained reductions in pain and disability over four years. BioWell stress showed modest discriminative ability as a biomarker. These findings are associative and require confirmation in controlled trials.

Background: Shoulder arthroplasty is performed for various etiologies, including osteoarthritis, proximal humerus fractures (PHFs), and rotator cuff tears. While previous studies have focused on outcomes based on implant choice, less is known about the independent effects of surgery type, comorbidities, and fracture status on postoperative outcomes. This study evaluates their influence on length of stay (LOS), in-hospital mortality, and postoperative complications. Methods: A retrospective cohort analysis of 664,545 patients undergoing anatomic total shoulder arthroplasty (ATSA), reverse total shoulder arthroplasty (RTSA), or hemiarthroplasty (HA) was conducted. Multivariable Poisson and logistic regression models assessed predictors of LOS, mortality, and complications. Results: Among 132,909 patients, 63.3% underwent RTSA, 31.3% underwent ATSA, and 5.4% underwent HA. Mean hospitalization was longest for HA (2.56 days) and RTSA (1.82 days) compared to ATSA (1.39 days; p < 0.001). Poisson regression confirmed that RTSA increased LOS by 24.1% versus ATSA (IRR = 1.24, p < 0.001), while HA had the highest LOS (IRR = 1.58, p < 0.001). Postoperative complications were observed in 8.37% of ATSA, 13.81% of RTSA, and 17.81% of HA cases (overall ~12.3%). Compared with ATSA, RTSA increased the odds of complications (OR = 1.48, p < 0.001), while HA presented the greatest complication risk (OR = 1.51, p < 0.001). Among proximal humerus fracture (PHF) patients (9.9% of the cohort), 84.7% underwent RTSA. PHF independently increased LOS (IRR = 1.61, p < 0.001), mortality (OR = 1.62, p = 0.051), and complications (OR = 2.33, p < 0.001). Conclusions: RTSA is associated with longer hospitalization and higher complication rates, while PHF worsens LOS, mortality, and complication risk.

Background/Objectives: Chronic low back pain (CLBP) affects approximately 20% of the global population and is a leading cause of years lived with disability. Long-term, real-world evidence for inhaled cannabis in patients refractory to conventional multimodal therapy remains scarce. We assessed the five-year efficacy and safety of inhaled cannabis in CLBP patients who had documented failure of ≥1 year of opioid analgesics, anticonvulsants, antidepressants, NSAIDs, and physiotherapy, with each patient serving as their own historical control. Methods: We analyzed prospectively collected clinical data from 241 consecutive adults with treatment-refractory CLBP (mean age 49.3 ± 14.9 years; 37.8% female; mean pain duration 15.1 years) initiated on inhaled medical cannabis (predominantly smoking, THC 4–22%, CBD 2–22%) in a single-center tertiary orthopedic clinic between 2020 and 2025 (Hasharon Hospital, Rabin Medical Center, Israel; IRB protocols 0807-21-RMC and 0634-25-RMC). Year-0 outcomes during conventional therapy were compared with outcomes at Years 1–5 on cannabis. Primary outcomes were the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory severity/interference (BPI-S/BPI-I). Concomitant-medication trajectories were a secondary outcome. The primary analysis was a mixed model for repeated measures (MMRM) with random intercept and slope, REML estimation, and time as a categorical fixed effect. Multiple imputation (MAR, m = 20, Rubin’s rules) was the primary missing-data approach; complete-case and tipping-point pattern-mixture sensitivity analyses were used. A multivariate Hotelling T² provided a joint test across the four correlated PROMs. Concomitant-medication discontinuation was modeled with GEE logistic regression and exact McNemar tests. Time to discontinuation was estimated by Kaplan–Meier and Cox regression. The Bonferroni-adjusted significance threshold for the four primary outcomes was α = 0.0125. BioWell gas-discharge-visualization (GDV) parameters were exploratory only. Results: Of 241 patients, 238 (98.8%) provided Year-5 data and 224 (92.9%) remained on cannabis at Year 5; only five patients (2.1%) discontinued for adverse events or inefficacy. All four primary PROMs improved markedly and durably. MMRM-estimated Year-5 minus Year-0 changes were: NRS −5.36 (95% CI −5.65, −5.07), ODI −17.68 (95% CI −19.73, −15.63), BPI-S −6.73 (95% CI −6.99, −6.47), and BPI-I −3.41 (95% CI −3.65, −3.16); all four contrasts had |z| ≥ 16.9 and p < 10⁻²⁰. MI-pooled estimates were within 0.05 of MMRM (FMI < 0.03 for all outcomes). Hotelling T² was F(4, 232) = 872.8, p < 10⁻²⁰. At Year 5, 89.2% achieved ≥30% NRS reduction, 77.2% ≥ 50%, and 93.4% met the NRS minimum clinically important difference (MCID); ODI MCID 65.6%, BPI-S MCID (≥1 pt) 98.3%, BPI-I MCID (≥1 pt) 91.3%. Concomitant opioid use fell from 100% at baseline to 4.6% at Year 5 (within-patient absolute risk reduction 95.4%, McNemar exact p = 1.16 × 10⁻⁶⁹), NSAID from 100% to 7.1%, SSRI/SNRI from 80.5% to 5.4%, and gabapentinoid from 38.6% to 2.5%. The ARR-derived NNT for opioid discontinuation was 1.05; this NNT is referenced to each patient’s own documented maximal-conventional-therapy state and is not equivalent to a between-arm randomized-trial NNT. Cannabis dose × time interaction was consistent with no pharmacological tolerance (β = −0.0044 per gram-month per year, p = 0.074). Across 1205 patient-years of cannabis exposure (calculated as 241 patients × 5 follow-up years from Year 1 through Year 5; baseline Year 0 represents pre-cannabis state and is not included in person-time on cannabis), 1338 organ-system AE events were recorded at 1.110/patient-year (Poisson 95% CI 1.05–1.17); 99.8% of graded events were mild (grade 1), with ocular (476 events, 0.40/PY), cognitive (460, 0.38/PY), and gastrointestinal (368, 0.31/PY) reactions predominating. The Year-3 retention dip reflected a documented telemedicine-clinic phenomenon during 2022–2024, with patients returning to in-person follow-up by Year 4–5. BioWell GDV discriminated NRS ≥ 4 only at chance level (BWS AUC 0.574, 95% CI 0.54–0.60; BWV AUC 0.51). Conclusions: In a treatment-refractory CLBP cohort with five-year longitudinal follow-up, inhaled cannabis was associated with large, sustained, and statistically robust improvements in pain, disability, and pain interference, accompanied by near-total displacement of opioids, NSAIDs, antidepressants, and gabapentinoids. These observational associations, although mechanically less susceptible to bias for the binary medication-discontinuation outcomes than for self-reported PROMs, cannot be interpreted causally in the absence of a concurrent randomized control arm and may reflect a combination of pharmacological effect, regression to the mean from a high pre-treatment baseline, expectancy and self-selection effects intrinsic to an actively chosen open-label therapy, and secular trends in pain reporting. The within-patient benefit-risk profile—ARR-derived NNT ≈ 1 for opioid sparing against a predominantly mild adverse-event burden—supports consideration of cannabis as a potentially clinically meaningful, opioid-sparing option in patients who have failed multimodal conventional therapy, pending confirmation in randomized comparative trials.

Background/Objectives: Hallux valgus (HV), a common foot deformity, is difficult to quantify beyond traditional angular measurements. This study introduces a novel dynamic distance mapping technique to visualize HV progression and identify spatial features linked to severity. Methods: A retrospective analysis of 335 feet from 178 patients undergoing HV surgery at Hasharon Hospital, Israel (2014–2024), utilized custom Python software to annotate 24 landmarks on preoperative standing anteroposterior radiographs. This generated 276 normalized Euclidean distances, analyzed via Pearson correlation against HV angles (HVA, IMA, DMAA, HIA). Results: Seven distances correlated negatively (r > 0.4, p < 0.05) and seven positively with HVA, involving the distal phalanx, sesamoids, and second metatarsal. Eleven distances showed strong positive correlation (r > 0.4, p < 0.05) with IMA, reflecting displacement patterns. Moderate correlations were observed with DMAA (six negative, r −0.3 to −0.4; two positive, r 0.3 to 0.4, p < 0.05) and HIA (two negative, r −0.3 to −0.4, p < 0.05). Visualizations highlighted progressive spatial changes. Conclusions: Dynamic distance mapping provides valuable insights into hallux valgus (HV) progression, as evidenced by significant correlations with HVA and IMA, supporting its potential role in surgical planning. However, its ability to capture 3D deformities requires validation against weightbearing computed tomography (WBCT). Future research should explore correlations with specific indications for corrective osteotomies to enhance clinical applicability.