Background: While outcomes of primary anatomic total shoulder arthroplasty (aTSA) are generally favorable, results after revision procedures are less reliable. This study examines the functional outcomes, complications, and implant survival in patients who underwent revision of aTSA to aTSA. Methods: Patients who underwent revision aTSA were identified from 2008-2015. Demographic, clinical, surgical, and outcomes data were analyzed. Patient-reported outcomes including the American Shoulder and Elbow Surgeons Score (ASES), Single Assessment Numerical Evaluation (SANE), Visual Analog Scale for pain (VAS), the Short Form-12 Health Survey (SF-12), and patient satisfaction were recorded. Results: Twenty patients underwent revision from a primary aTSA to aTSA (55% male, 62. 0± 6. 8 years-old). Revision aTSA occurred at 2. 5± 3. 4 years after index surgery. Seven (35%) required future revision at 1. 8± 1. 9 years after revision aTSA. Among the 13 patients who did not undergo revision, twelve (92. 3%) had over two-year follow-up (4. 0± 2. 4 years). Average ASES score was 70. 1± 23. 5, SANE 66. 0± 29. 4, VAS 2. 7± 3. 0, SF-12 Mental 52. 4± 10. 5, SF-12 Physical 36. 8± 8. 9, and satisfaction of 3. 6± 1. 2. Conclusion: Results of revision aTSA to aTSA were unpredictable and the revision rate was high. The cases that do not undergo revision had satisfactory, but inconsistent functional results. Reverse arthroplasty may be more reliable in this patient population.

Background: The projected increase in revision shoulder arthroplasty has increased interest in the outcomes of these procedures. Glenoid component removal and conversion to a hemiarthroplasty (HA) is an option for aseptic glenoid loosening after anatomic total shoulder arthroplasty (aTSA). Methods: We identified patients who had undergone revision shoulder arthroplasty over a 15-year period. 17 patients met inclusion and exclusion criteria, and a retrospective chart review was conducted for pre-surgical and operative data. We contacted patients at a mean follow-up of 70 months from revision surgery for implant survival, reoperations and functional outcomes scores. Results: Implant survival was estimated to be 88% at 2 years and 67% at 5 years. Mean ASES score for surviving implants was 58 ± 22. Mean SANE score was 54 ± 24, and mean VAS pain score was 3. 5 ± 2. 8. Mean SF-12 Mental and Physical scores were 46 ± 15 and 38 ± 10, respectively. Five patients (50% of those with surviving implants) reported being either very satisfied or satisfied with the status of their shoulder. There were complications in 6 patients (35%) and 5 patients (29%) required reoperation. Conclusion: HA following failed aTSA due to glenoid loosening produced modest clinical results and satisfaction rates. Reverse arthroplasty may be a more reliable treatment strategy in this patient population.

Background: Modern glenoid cementing techniques for anatomic total shoulder arthroplasty has improved the ability to achieve a stable cement mantle, but the efficacy of adjunctive agents in glenoid preparation is unclear. The purpose of this study is to compare the early radiolucency rates of glenoids prepared with and without thrombin. Methods: We identified patients between January 2017 and February 2019 undergoing primary anatomic TSA using two glenoid types. Group A glenoids had a cemented central peg without peripheral peg cementation, and Group B glenoids had cemented peripheral pegs without central peg cementation. The first postoperative radiograph was assessed for radiolucent lines. All patients had the same glenoid preparation except some had the addition of thrombin as a preparation agent. Results: We identified 83 Group A glenoids with and 63 without thrombin glenoid preparation, and109 Group B glenoids with and 48 without thrombin preparation. All Group A glenoids had no radiolucent lines and 5 (3%) Group B glenoids had radiolucent lines. Use of thrombin showed no difference in early radiolucencies (p=1. 00) in either Group. Conclusion: The addition of thrombin as a preparation agent had no effect on early glenoid radiolucent lines in anatomic TSA, and its routine use should be reconsidered.

Objectives: There have been conflicting reports regarding the effects of obesity on both surgical time and blood loss following anatomic shoulder arthroplasty. Varying categories of obesity has made comparison amongst existing studies difficult. Methods: A retrospective review of consecutive anatomic shoulder arthroplasty cases (aTSA) was undertaken. Demographic data, including age, gender, body mass index (BMI), age-adjusted Charleson Comorbidity Index (ACCI), operative time, hospital length of stay (LOS), and both POD#1 and discharge visual analogue score (VAS) was collected. Intra-operative total blood volume loss (ITBVL) and need for transfusion was calculated. BMI was categorized as non-obese (<30 kg/m2), obese (30-40 kg/m2) and morbidly obese (≥, 40 kg/m2). Unadjusted associations of BMI with operative time, ITBVL and LOS were examined using Spearman correlation coefficients. Regression analysis was used to identify factors associated with hospital LOS. Results: There were 130 aTSA cases performed, including 45 short stem and 85 stemless implants, of which 23 (17. 7%) were morbidly obese, 60 (46. 2%) were obese and 47 (36. 1%) were non-obese. Median operative time for the morbidly obese cohort was 119. 5 minutes (IQR 93. 0, 142. 0) versus 116. 5 minutes (IQR 99. 5, 134. 5) for the obese cohort versus 125. 0 minutes (IQR, 99. 0, 146. 0) for the non-obese cohort. (P=0. 61) The median ITBVL for the morbidly obese cohort was 235. 8 ml (IQR 144. 3, 329. 7) versus 220. 1 ml (IQR 147. 7, 262. 7) for the obese cohort versus 216. 3 ml (IQR 139. 7, 315. 5) for the non-obese cohort. (P=0. 72). BMI ≥, 40kg/m2 (IRR 1. 32, P=0. 038), age (IRR 1. 01, P=0. 026), and female gender (IRR 1. 54, P<0. 001) were predictive of increased LOS. There was no difference with regards to in-hospital medical complications (P=0. 13), surgical complications (P=1. 0), need for re-operation (P=0. 66) and 30-day return to the ER (P=0. 06). Conclusion: Morbid obesity was not associated with increased surgical time, ITBVL and perioperative medical or surgical complications following aTSA, though it was predictive of increased hospital LOS.

Objectives: The purpose of this analysis is to present a two-year follow-up of patient-reported outcomes, revision rate, and notable radiographic features of a convertible, diaphyseal-fit anatomic total shoulder arthroplasty system (ATSA). Methods: From June 2012 to June 2015, 100 shoulders were treated with ATSA using a convertible, diaphyseal-fit stem. Functional outcomes and radiographic findings were assessed preoperatively and at 6 months, 1 year, and 2 years postoperatively. Complications and reoperations were also determined. Results: Ninety-three shoulders were analyzed in this study. Patients were 47. 3% male and had an average age of 67. 3±, 8. 1-years-old (range 44. 7-89. 1). Two-year clinical outcomes show a revision rate of 4. 3%. Average preoperative ASES was 37. 1±, 18. 9 (6. 7-86. 7), SST (77. 4%) was 3. 1±, 2. 4 yes responses (0-9), and SANE (88. 2) was 25. 4±, 21. 5% (0-85. 0%). At two years post-operative average (75% follow-up) ASES was 89. 3±, 15. 1 (37. 0-100), SST was 10. 0±, 2. 5 yes responses (0-12), and SANE was 85. 6%±, 17. 0% (33. 0-100%). Radiographic analysis at two years identified 2 shoulders (4%) with glenoid radiolucency (both Lazarus grade 1), 5 shoulders with at least one humeral radiolucent line (10%), and 9 shoulders (18%) with stress-shielding. There were 12 shoulders (24%) with distal pedestal formation. This finding was associated with the presence of radiolucent lines (P=0. 002). Conclusion: This two-year analysis identified improvement in ASES, SST, and SANE scores and a low revision rate. Presence of a distal pedestal was associated with increased rates of radiolucent lines. Further analysis with longerterm and more robust follow-up will improve our understanding of the risks and benefits of this shoulder system.

Background: The Global Unite Shoulder System is the next generation of implant from the Depuy Global Shoulder line. The primary feature of the Global Unite is adaptability through the interchangeable modular bodies, modular suture collars, and stems. Short-term functional and radiographic outcomes of the Global Unite Platform Shoulder System were assessed as well as complication and revision rates. Methods: 95 subjects were enrolled prospectively between 2013 and 2015 that underwent anatomic or reverse shoulder arthroplasty utilizing the DePuy Global Unite Anatomic Platform Shoulder System. Functional outcome data (ASES and SANE) as well as radiographic data was collected on these patients pre-operatively, and at 6 months, 1 year and 2 years post-operatively. Results: The cohort consisted of 97 shoulders in 95 patients of which 54 (56. 8%) are males and 41 (43. 2%) are female. There were 55/97 (56. 7%) were primary anatomic total shoulder arthroplasties, 37/97 (38. 1%) primary reverse shoulder arthroplasties, and 3/97 (3. 1%) revision procedures to a reverse shoulder arthroplasty. Outcome scores demonstrated an increase in ASES score from a mean of 33. 00 to 79. 56 and SANE score of 21. 30 to 84. 08. Conclusion: The Depuy Global Unite shoulder system demonstrated very good short-term results in this two-year outcome study. Functional outcome scores are similar to current literature for anatomic and reverse primary cases. Radiographic measures at two years are promising with only 2 cases of grade 1 scapular notching and one case of grade 2 scapular notching. Overall the Depuy Global Unite is a versatile shoulder system with very good early outcomes.

Background: The object of this study was to examine return to golf and changes in golf performance after shoulder arthroplasty. Additionally, we set out to determine if there were differences in return to play and performance between total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA). We also examined pain during the golf swing to determine if there is a change in pain level after surgery. Methods: Patients were identified using a Current Procedural Terminology code 23472 search for TSA. A 19-question online survey was sent out to each patient with questions detailing golfing performance and pain during the swing before and after surgery. Comparisons were made to determine differences in pain, performance and enjoyment between TSA and RTSA groups before and after surgery. Results: A total of 586 patients who underwent shoulder arthroplasty were sent the online survey via email. Of those patients, 33 identified themselves as golfers and who responded to the survey, resulting in an overall response rate of 5. 6%. Twenty-three of 31 (74%) patients were able to return to golf following their procedure. Overall, the respondents who reported pain associated with golfing activity had significantly decreased pain after undergoing either TSA or RTSA. The RTSA group had a significant drop in driving distance following the procedure and this was significantly lower than the postoperative driving distance in the TSA group, despite an insignificant preoperative difference. Conclusion: Overall, TSA offers a safe and effective means for reducing pain during the golf swing in patients suffering from advanced shoulder osteoarthritis. While there were no significant changes in performance following TSA, individuals undergoing RTSA can be counseled that they are at risk for lower driving distances due to altered mechanics. Overall, patients were satisfied with their procedure and their ability to return to the golf course.