Search Results (249)

Background/Objectives: Reverse total shoulder arthroplasty (rTSA) is the preferred treatment for elderly patients with complex proximal humerus fractures. Accurate humeral stem positioning remains challenging in these cases due to complex fracture patterns, which may lead to postoperative complications. Virtual surgical planning (VSP) may assist in optimizing humeral stem and greater tuberosity positioning; however, its clinical impact in fracture-related rTSA has not yet been evaluated. This study aimed to assess whether VSP improves postoperative range of motion (ROM). Methods: A comparative cohort study was conducted, comprising a prospective VSP group and a retrospective control group. Patients underwent rTSA for proximal humerus fractures. Primary outcomes were ROM during forward elevation, abduction, and external rotation at two months and one year postoperatively. Secondary outcomes included complications, procedure time, greater tuberosity repositioning and healing, and postoperative deviation in humeral stem height compared with the preoperative plan. Statistical analyses included independent t-tests, Mann–Whitney U tests, and chi-square tests. Results: A total of 48 patients were included: 27 in the VSP group and 21 in the non-VSP group. At two months, abduction was significantly greater in the VSP group (76° vs. 63°, p = 0.05). Forward elevation and external rotation were numerically higher in the VSP group but did not reach statistical significance (p < 0.1). Stem height deviation was significantly lower in the VSP group (3 mm vs. 12 mm, p < 0.001). Conclusions: VSP enables more accurate humeral stem positioning in rTSA for proximal humerus fractures. Although no statistically significant improvements in ROM were observed at one year, VSP demonstrated superior accuracy in stem positioning. Full article

Background: Artificial intelligence (AI) is becoming increasingly integrated into orthopaedic surgery for tasks such as implant positioning, dislocation risk prediction, and surgical decision-making. However, the current evidence varies widely across anatomical regions and applications. Methods: A structured narrative review was conducted using PubMed and Web of Science Core Collection to identify studies applying machine learning or deep learning in orthopaedic procedures, focusing on parameters such as the anatomical region addressed, data types used, primary AI tasks, evaluation designs, and validation strategies. Reviews and meta-analyses were excluded. Study selection was summarized using a PRISMA-style flow diagram, and included studies were narratively synthesized according to anatomical region, AI task, imaging modality, validation strategy, and clinical relevance. Results: We identified three main application areas: (1) AI in imaging-driven planning and implant positioning, often linked with navigation or robotic systems; (2) postoperative evaluation related to implants; and (3) prediction of clinically relevant outcomes such as dislocation risk. The strongest evidence is found in hip arthroplasty, where AI improves measurement accuracy and workflow efficiency, whereas applications in knee, shoulder, and spine surgery are less developed and often supported by smaller studies. Although existing risk prediction models demonstrate good performance, their generalizability is hindered by limited external validation and inconsistent reporting. Conclusions: Overall, while AI shows significant promise in enhancing various aspects of orthopaedic surgery, stronger links between technical advancements and patient outcomes are needed. Future research should prioritize extensive validations, workflow-aware evaluations, failure analysis, and adherence to AI-specific reporting guidelines to facilitate safe and effective clinical implementation. Full article

We investigated whether bone morphology alone can inform implant selection in shoulder arthroplasty using a hypothesis-driven deep learning framework applied to preoperative computed tomography (CT) scans. The proposed approach extends a previously validated segmentation and pathology-staging pipeline by introducing implant-type prediction and a controlled human–AI comparison. The workflow combines CEL-UNet for 3D bone segmentation with ArthroNet⁺, a multi-task network assessing osteophytes, joint-space narrowing, humeroscapular alignment, and implant type. Trained on a multicenter cohort of 600 patients, CEL-UNet achieved Dice scores of 0.99 for the humerus and 0.98 for the scapula. ArthroNet⁺ achieved high performance in pathology classification (up to 95% for alignment tasks). Under morphology-only conditions, ten orthopedic surgeons achieved 61% accuracy with low inter-rater agreement (Fleiss’ $\mathsf{\kappa }\approx 0.15$), while the model reached 78% agreement with the implant choices observed in the dataset, reflecting the ability to reproduce clinical decision patterns rather than to identify an optimal implant selection. This performance is characterized by a class-dependent asymmetry, with higher recall for reverse implants than for anatomical ones. These findings indicate that bone morphology provides a measurable but incomplete signal for implant selection, and should therefore not be interpreted as reflecting clinical decision-making performance. The framework quantifies the morphology-driven component of surgical decision making under controlled conditions, supporting future integration with multimodal clinical data. Full article

Background/Objectives: Interscalene brachial plexus block (ISB) is a common regional anesthesia technique for analgesia in patients undergoing shoulder surgery. Liposomal bupivacaine (LB) was developed to prolong analgesia duration; however, the existing literature demonstrates mixed results regarding its efficacy. This study aimed to compare the analgesic effectiveness of near-equipotent doses of LB and plain bupivacaine (PB) for patients undergoing total shoulder arthroplasty (TSA). Methods: This prospective double-blinded randomized controlled trial enrolled 78 elective TSA patients. Participants were randomized to receive an ISB with either 36 mL of 0.5% PB (180 mg) or a mixture of 10 mL of LB, 20 mL of 0.25% PB, and 6 mL of saline (183 mg). The primary outcome was the proportion of patients with clinically tolerable pain scores (visual analog scale (VAS) ≤ 4) on postoperative day (POD) 1 in each group. Secondary outcomes included the proportion of patients with clinically tolerable pain scores on POD 2–5, overall pain scores in the post-anesthesia care unit (PACU) and on POD 1–5, Quality of Recovery Survey-15 (QoR-15) scores on POD 1–5, analgesic consumption on the day of surgery and on POD 1–5, and adverse events. Results: A total of 67 patients completed the study. There was a statistically significant increase in median body mass index (BMI) in the PB vs. LB group (30.0 (27.4–33.1) vs. 27.0 (24.3–29.4), p = 0.0197). All other demographic characteristics were comparable between groups. There was no difference in the primary outcome or any of the secondary outcomes. Conclusions: LB did not reduce postoperative pain compared to PB. Larger, multicenter studies are warranted to further evaluate the clinical benefit of LB in this population. Full article

Purpose: The treatment of proximal humerus fractures (PHFs) remains debated, and similar fracture patterns may be managed with different strategies. The aim of this retrospective single-center case series without a control group was to evaluate clinical and radiographic outcomes after treatment of selected PHFs with the Galaxy Fixation System. The primary endpoint was functional recovery at 12 months, assessed using the Constant Shoulder Score and QuickDASH. Secondary endpoints included radiographic maintenance of reduction, quality of life, treatment-related complications, and need for revision surgery. Methods: We retrospectively analyzed 48 consecutive patients with proximal humeral fractures treated at the Orthopaedic and Traumatology Unit of Versilia Hospital, Viareggio, Italy, between November 2017 and February 2022. Fractures were assessed using trauma-series radiographs and computed tomography when required, and were classified by two senior surgeons according to the Neer, AO/OTA, and Hertel classifications. Eligible patterns included 2-part, 3-part, and selected 4-part fractures with at least two-thirds of intact metaphyseal bone stock. Results: Forty-six patients completed the 12-month follow-up; two patients died during follow-up from causes unrelated to the index procedure. The mean Constant Shoulder Score improved from 62.7 at 6 months to 69.3 at 12 months, and the mean QuickDASH improved from 9.4 to 8.1. The mean postoperative head-shaft angle was 137.2 degrees and remained substantially stable at 135.1 degrees at 12 months. Pin-tract infection occurred in 5 patients, pin migration in 4, algodystrophic syndrome in 1, and avascular necrosis requiring revision arthroplasty in 1. Conclusions: In this retrospective uncontrolled series, external fixation with the Galaxy system was associated with progressive functional recovery, satisfactory radiographic maintenance of reduction, and a low rate of revision surgery in carefully selected PHFs. These findings should be interpreted cautiously because of the retrospective design, limited sample size, absence of a control group, incomplete availability of some baseline variables, and lack of formal comparative or cost-effectiveness analyses. Full article

Background and Objective: This study aimed to evaluate the impact of early functional rehabilitation on clinical outcomes and tuberosity healing in older patients undergoing reverse shoulder arthroplasty for proximal humeral fractures. We hypothesized that early functional rehabilitation would not compromise tuberosity healing and would result in comparable or improved outcomes versus postoperative immobilization. Methods: This retrospective matched-pair analysis included patients aged 70 years or older who underwent reverse shoulder arthroplasty for proximal humeral fractures, with 12 to 24 months of follow-up. Group allocation was time-based: earlier patients received immobilization and later patients underwent early rehabilitation. Matching was based on sex, age, body mass index, fracture classification (Neer), and glenosphere size. Outcomes included patient-reported scores, range of motion, and radiographic assessment of tuberosity healing using standardized imaging. Results: Forty patients (20 per group) with a mean age of 80.7 years and a mean follow-up of 16.1 months were included. The early rehabilitation group demonstrated significantly higher Constant scores (p = 0.044), age- and sex-adjusted Constant scores (p = 0.033), and greater active external rotation (p = 0.002). Anatomical tuberosity healing was seen in 28 of 40 patients (70%). Greater tuberosity healing occurred in 75% and lesser tuberosity healing in 85% of patients with available axial imaging. One deep infection occurred in the early rehabilitation group and was successfully managed. Conclusions: Early functional rehabilitation after reverse shoulder arthroplasty in older adults with proximal humerus fractures improved functional outcomes without compromising tuberosity healing. Full article

Background: In reverse shoulder arthroplasty (RSA), preservation of the subscapularis (SSC) has gained attention because of its biomechanical and functional significance. However, when SSC preservation is attempted using the conventional deltopectoral (DP) approach, glenoid visualization and instrument access may be limited. The purpose of this Technical Note is to describe a modified deltopectoral exposure technique, hereafter referred to as the Margin-Shifted, Yawing, Subscapularis-Sparing, and Transitioned Lateralized Deltopectoral (MYST–LDP) approach, and to assess its feasibility in primary RSA. Methods: The MYST–LDP approach incorporates a laterally shifted incision apex, a proximally oriented curved arc (“yawing”) toward the acromion, complete preservation of the subscapularis, and a distally transitioned limb aligned with the anterior humeral axis. We describe the surgical technique and our initial experience in three consecutive primary RSA cases performed using an inlay implant system to minimize humeral lateralization and allow focused assessment of exposure geometry. Results: In all cases, the SSC was preserved without conversion to a standard DP exposure. Adequate glenoid visualization was achieved using three retractors without excessive soft-tissue tension, allowing controlled glenoid preparation and component implantation without additional exposure or conversion. No approach-related intraoperative complications were observed. Conclusions: The MYST–LDP approach is a feasible modification of the deltopectoral exposure that preserves both SSC and the deltoid while facilitating glenoid visualization and instrument alignment. This technique represents an ergonomic and tissue-preserving option within the familiar DP framework for surgeons performing SSC-preserving RSA. Further comparative and quantitative studies are warranted to determine its clinical value. Full article

Background/Objectives: Shoulder disorders are among the most prevalent musculoskeletal conditions, with lifetime prevalence reaching 67% and substantial associated disability and economic burden. Geographic barriers and workforce shortages impede access to optimal rehabilitation. This narrative review aims to synthesize current evidence on tele-diagnostics and tele-rehabilitation in shoulder disorders, evaluate clinical outcomes and implementation factors, and explore models for integrating these complementary approaches. Methods: A structured but non-systematic literature search was conducted across PubMed, Scopus, and Web of Science covering publications from January 2010 through December 2025, using terms related to telehealth, tele-rehabilitation, tele-diagnostics, and shoulder disorders. Priority was given to randomized controlled trials, systematic reviews, feasibility studies, and clinical practice guidelines in adult populations. A total of 97 articles were included in the final narrative synthesis. Results: Tele-diagnostic approaches demonstrate acceptable reliability for range-of-motion assessment and general diagnostic classification, though glenohumeral instability evaluation remains challenging remotely. Multiple randomized controlled trials suggest non-inferior outcomes for tele-rehabilitation compared to conventional physiotherapy across rotator cuff repair, shoulder arthroplasty, and conservative management, with generally high patient satisfaction. Certainty of evidence is currently low to moderate due to short follow-up durations, modest sample sizes, and heterogeneous protocols. Key implementation barriers include the digital divide, inability to deliver manual therapy, and insufficient long-term outcome data. Conclusions: Current evidence supports telehealth as a viable complement to conventional shoulder care, with the strongest evidence base for postoperative tele-rehabilitation. Hybrid care models appear clinically feasible, though widespread adoption requires standardized outcomes, longer-term trials, and strategies addressing health equity barriers. Full article

Background/Objectives: Arthroscopic rotator cuff repair (ARCR) and reverse shoulder arthroplasty (RSA) are among the most commonly used surgical treatment methods. A growing number of studies assess the changes in the biomechanical and viscoelastic properties of the muscles and tendons surrounding the shoulder joint. Therefore, the aim of this study was to review the literature to determine how the biomechanical properties of the muscles surrounding the shoulder joint change as a result of ARCR and RSA, and whether MyotonPRO was used in this group of patients. Methods: A review of the international scientific literature was conducted in September 2025. The study was based on searches of the following databases: Google Scholar, PubMed, Scopus, and Web of Science. A final total of 32 articles were included in the review. Results: In this article, we have shown that ARCR and RSA procedures cause changes in the biomechanical properties of the muscles surrounding the shoulder joint. We also demonstrated that MyotonPRO has been used in this group of patients in a limited number of studies. However, the studies confirm that it is a reliable tool for examining upper limb muscles. Conclusions: This literature review demonstrates a new direction in research using MyotonPRO. Using this device in muscle testing in patients after ARCR and RSA will allow for a better understanding of the changes that occur in muscles as a result of these procedures, as research in this area is new and incomplete. Full article

Background: Reverse shoulder arthroplasty (RSA) relies on secure baseplate fixation to the glenoid. This carries a risk of suprascapular nerve (SSN) injury during peripheral screw insertion. Although fixed safe zones have been described, it remains unclear whether these scale with scapular morphometry or whether common screw positions confer differential SSN risk. Methods: Twenty cadaveric shoulders (ten pairs) were dissected. The superior safe zone (distance from the supraglenoid tubercle to SSN at the suprascapular notch) and posterior safe zone (distance from the glenoid rim to SSN at the spinoglenoid notch) were measured. Scapular dimensions (height, spine length, width) were measured. In ten shoulders, simulated RSA baseplate fixation was performed with superior screws placed at 11, 12, or 1 o’clock and posterior screws at 8, 9, or 10 o’clock. Screw lengths were based on glenoid depth. Cortical breach and SSN proximity were recorded. Linear regression assessed relationships between scapular dimensions and safe zones. Results: The superior safe zone (mean 2.9 ± 0.5 cm) significantly correlated with scapular dimensions (r = 0.78–0.86; p < 0.0001). All superior screws remained intraosseous across configurations. The posterior safe zone (1.9 ± 0.6 cm) showed no correlation. Posterior cortical breach occurred in 50% of specimens across all tested positions and was associated with smaller scapular spine length (p = 0.027). No significant difference in SSN proximity was observed between posterior screw positions. Conclusions: Scapular dimensions predict the superior, but not posterior, safe zone. Scapulae with shorter spine lengths demonstrated increased risk of posterior cortical breach, independent of screw position. These findings establish anatomical scalability of the superior safe zone and suggest that scapular morphometry may inform preoperative RSA planning; however, prospective validation is needed before routine clinical implementation. Full article

Shoulder pain and shoulder surgery are increasingly prevalent and encompass a broad spectrum of pathologies, including rotator cuff disease, glenohumeral osteoarthritis, and shoulder instability. Growing evidence suggests that gender-related factors influence disease presentation, patient-reported outcomes, and postoperative recovery; however, these effects remain inconsistently reported across the literature. This current concepts review synthesizes available evidence on the influence of gender on pre-operative characteristics, non-operative management, and postoperative outcomes following common shoulder procedures, including rotator cuff repair, anatomic and reverse shoulder arthroplasty, and surgical stabilization for instability. A comprehensive literature search of PubMed, the Cochrane Library, and Google Scholar was performed for studies published through October 2025, with outcomes assessed using validated instruments such as the Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons score, Constant–Murley score, Simple Shoulder Test, Visual Analog Scale, and Shoulder Pain and Disability Index. Across shoulder pathologies, female patients consistently demonstrated worse pre-operative functional scores, higher pain levels, and greater perceived disability despite similar structural disease severity. Postoperatively, both genders experienced meaningful clinical improvement; however, females often reported higher early postoperative pain and lower absolute functional outcomes, particularly following shoulder arthroplasty for glenohumeral osteoarthritis and surgical treatment of multidirectional instability. In contrast, outcomes following rotator cuff repair and anterior instability stabilization were largely comparable between genders. Recognition of these gender-related differences is essential for individualized patient counseling, expectation setting, and optimization of management strategies, and highlights the need for future studies with robust gender-disaggregated analyses. Full article

Background/Objectives: The prevalence of joint replacement surgeries has significantly increased over the last century, leading to a corresponding rise in complications, particularly periprosthetic joint infection (PJI). The management of a PJI involves various strategies, including debridement, antibiotic therapy, and staged revision procedures. A notable advancement in treatment is the use of calcium sulfate reabsorbable carriers, recognized for their biocompatibility, osteoconductivity, and localized antibiotic delivery. Recent reports indicate that when combined with conventional treatment regimens, calcium sulfate carriers can achieve infection eradication rates exceeding 90%. This study aims to evaluate the efficacy of calcium sulfate carriers in managing periprosthetic infections, specifically assessing their impact on healing rates in patients undergoing treatment. Study Design & Methods: A retrospective analysis was conducted at our institution, focusing on patients diagnosed with PJIs treated with 2-stage revision surgery with local application of calcium sulfate carriers with antibiotics at both stages, and systemic antibiotic therapy, and comparing results with different surgical procedures. Results: The study included 40 patients (24 males and 16 females), with a mean age of 68.7 (range 48–87) years. The affected joints included the hip (27.5%), shoulder (27.5%), and knee (45%). The findings revealed that 97% of patients achieved infection eradication at the end of the follow-up period. Conclusions: These results highlight the complexities of managing PJIs and the significant role of calcium sulfate carriers in improving outcomes, supporting their use as a standard practice in confirmed PJI cases. Full article

Background: Reconstruction of the proximal humerus after wide tumor resection is technically demanding, and traditional methods such as allograft–prosthetic composites, reverse shoulder arthroplasty, and metal implants are limited by graft unavailability, pediatric size mismatch, their high cost, and metal-related stress shielding. Polyether ether ketone (PEEK), with its modulus closer to cortical bone and radiolucency, offers a promising alternative. Building upon the success in craniomaxillofacial surgery and its favorable physical characteristics, we applied personalized 3D-printed PEEK implants for proximal humerus reconstruction. This study reports the first evidence of applying patient-specific 3D-printed PEEK implants in the proximal humerus. Methods: A retrospective cohort study was conducted on seven patients who underwent wide resection of primary malignant bone tumors of the proximal humerus, followed by reconstruction using patient-specific 3D-printed PEEK implants. Implant design was based on preoperative computed tomography (CT) imaging, incorporating contralateral humeral mirroring and computer-aided design. The implants were fabricated using fused deposition modeling (FDM) with medical-grade PEEK under stringent thermal control (nozzle temperature > 400 °C and heated build chamber), followed by a controlled annealing process to minimize internal stress, optimize polymer crystallinity, and enhance mechanical durability. Outcomes assessed included implant survival, oncologic control, shoulder range of motion, and functional outcomes measured using the Musculoskeletal Tumor Society (MSTS) score. The mean follow-up duration was 56.3 months. Results: All patient-specific PEEK implants were successfully manufactured and implanted with satisfactory geometric accuracy. Mechanical implant survival was 85.7% at final follow-up, with one implant fracture occurring at 28 months. No cases of deep infection, dislocation, loosening, or permanent neurovascular injury were observed. Local soft-tissue recurrence occurred in two patients (28.6%), without distant metastasis or tumor-related mortality. The limb-salvage rate was 100%. At final follow-up, the mean MSTS score was 23.0 ± 1.6. Shoulder motion was limited but comparable to outcomes reported for conventional anatomic megaprosthetic reconstructions. Conclusions: Patient-specific 3D-printed PEEK implants provide a feasible and oncologically safe option for proximal humerus reconstruction after tumor resection, with acceptable midterm implant survival and functional outcomes. The favorable elastic modulus and radiolucency of PEEK offer distinct biomechanical and imaging advantages over metallic implants. Further design optimization and larger prospective studies are warranted to enhance mechanical durability and functional restoration. Full article

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. Full article