EFORT Open Rev. 2025 May 5;10(5):277-285. doi: 10.1530/EOR-2024-0020.

ABSTRACT

PURPOSE: The objective was to investigate the consistency in cumulative revision rates (CRRs) for a selection of total hip arthroplasty cups and stems across national/regional hip arthroplasty registries worldwide.

METHODS: Ten cups and ten stems from total hip systems were randomly selected. Two frequently used implants across registries were added, totalling 11 cups and 11 stems. CRRs and 95% CIs were extracted from the latest annual registry reports using these implants. CRRs were pooled for each cup or stem, and differences between cup-stem combinations and between registries were investigated.

RESULTS: CRRs were available for ten cups and eight stems from eight registries, totalling 552,148 cups and 727,447 stems. Follow-up was 1-20 years. The 5-year CRR pooled for all cups was 2.9% (95% CI: 2.3-3.6) and for all stems, 3.0% (95% CI: 2.4-3.8). Homogeneous (consistent) CRRs with respect to both associated implant and country were observed for two cups and three stems. Significant differences in CRR were identified in one cup by associated implant only, in one cup by registry only, and in two cups and four stems for both. Sparse data prevented evaluation of four cups and one stem.

CONCLUSION: Registries' annual reports provide a large amount of publicly available information on CRRs of specific implants. These CRRs can be synthesised to improve the assessment of implant performance over time. Our CRR analysis represents a promising approach to detect implants with a consistent low- or high-risk pattern across registries.

PMID:40326530 | PMC:PMC12061013 | DOI:10.1530/EOR-2024-0020

EFORT Open Rev. 2025 May 5;10(5):213-223. doi: 10.1530/EOR-2023-0100.

ABSTRACT

Arthroscopic ankle arthrodesis (AAA) has been performed for 40 years for end-stage ankle osteoarthritis. Along with open ankle arthrodesis (OAA) and total ankle replacement (TAR), it forms one arm of the triumvirate of commonly performed procedures for this condition. The aim of this article is to review the state of the art for AAA and compare outcomes with OAA and TAR. This narrative review of the literature traces the development of this technique through case series and systematic reviews. Traditional OAA techniques carry a nonunion rate of 11%, necessitating revision surgery in most cases. As individual and communal experience of AAA has grown, the range of pathology and deformity successfully corrected by this technique has developed. There is evidence that AAA offers greater and more rapid union rates, with reduced hospital stay and better long-term outcomes. However, the technique requires mature surgical skills and still carries a significant complication rate. No single procedure is suitable for all patients. AAA can be seen as the new gold standard for patients with isolated ankle osteoarthritis and no/minimal deformity, either within the talocrural joint or hindfoot or patients with systemic and/or local comorbidities that would benefit from minimal disturbance to the soft-tissue envelope. However, in older patients, the presence of concomitant hindfoot osteoarthritis or significant deformity, TAR and OAA remain valuable procedures in the foot and ankle surgeon's armamentarium.

PMID:40326529 | PMC:PMC12061018 | DOI:10.1530/EOR-2023-0100

EFORT Open Rev. 2025 May 5;10(5):286-296. doi: 10.1530/EOR-2023-0184.

ABSTRACT

The piriformis muscle (PM) is important for posture and preventing falls. It is a key landmark for hip surgery. The PM function is reported to be increasingly important for improving total hip arthroplasty (THA) outcomes and reducing complications. This scoping review aims to map and summarize the literature on the anatomy and function of the PM and the outcomes of clinical studies on THA preserving the PM to improve readers' understanding and identify areas for further research. A scoping review following the PRISMA guidelines was conducted using PubMed and Scopus from their inception until June 2023. We used the search term 'piriformis' or 'PM' to include all PM-related studies. Two independent reviewers screened abstracts and full texts to select key aspects of PM anatomy and function and the main clinical THA studies reporting outcomes on PM preservation. Fifty-seven studies published between 1980 and 2023 met our inclusion criteria. During hip surgery, the PM anatomy, including its origin and insertion, muscle belly, and relation to other short hip rotators and the sciatic nerve, can vary greatly, making it difficult to recognize. The current literature on PM-preserving THA and hemiarthroplasty clinical studies is limited. It suggests potential benefits in terms of hip stability, dislocation risk, and functional outcomes compared to no PM preservation in short-term follow-up. Identifying and preserving the PM during hip surgery may be difficult due to its variable anatomy and its relation to surrounding structures. Although the literature supporting PM preservation potentially indicates better outcomes, further high-level research studies are needed.

PMID:40326528 | PMC:PMC12061017 | DOI:10.1530/EOR-2023-0184

EFORT Open Rev. 2025 May 5;10(5):309-315. doi: 10.1530/EOR-2024-0142.

ABSTRACT

OBJECTIVE: To investigate the efficacy of autologous bone marrow mesenchymal stem cell (BMSC) transplantation in patients with spinal cord injury (SCI) using meta-analysis, aiming to provide evidence-based guidance for clinical practice.

METHODS: Electronic databases such as PubMed, Web of Science, Cochrane Library and Embase were searched. Studies comparing the therapeutic effects of autologous BMSC transplantation and rehabilitation therapy on patients with SCI were included. The pooled effect size of autologous BMSC transplantation on the American Spinal Injury Association (ASIA) scores was calculated using the random- or fixed-effects model.

RESULTS: A total of seven eligible studies involving 288 patients with SCI were included in this study. The meta-analysis results showed that autologous BMSC transplantation significantly improved ASIA sensory scores (mean difference (MD): 8.80; 95% confidence interval (CI): 5.93, 11.67), ASIA motor scores (MD: 7.94; 95% CI: 2.05, 13.83), ASIA grade improvement (odds ratio (OR): 4.88; 95% CI: 2.48, 9.61) and somatosensory evoked potential improvement (OR: 3.34; 95% CI: 1.54, 7.25). This study did not find a statistically significant positive effect of autologous BMSC transplantation on bladder function and adverse events.

CONCLUSION: The therapeutic efficacy of autologous BMSC transplantation is encouraging, but further multicentre, large-sample, prospective studies are still needed.

PMID:40326527 | PMC:PMC12061012 | DOI:10.1530/EOR-2024-0142

Injury. 2025 Apr 25;56(7):112361. doi: 10.1016/j.injury.2025.112361. Online ahead of print.

ABSTRACT

BACKGROUND: The rise in scooter, skateboard, and e-scooter use in the U.S. has led to increased injuries, with distinct fracture patterns across vehicle types. This study aims to identify trends and patterns in fractures and injuries.

METHODS: This study used the PearlDiver database to examine skateboard, scooter, and e-scooter injuries and associated fractures across the United States from 2010 to 2022, categorized by anatomical site using ICD-9 and ICD-10 codes. E-scooter data were analyzed separately for 2020-2022. Injury and fracture rates were analyzed by age, sex, and state, with annual trends compared over the study period. Fracture incidence was calculated per 100,000 individuals and per 100 injuries.

RESULTS: From 2010 to 2022, skateboards accounted for the highest injury rates, with a rate of 8.72 per 100,000 individuals in 2022. Male injury rates consistently exceeded female rates across all vehicles during the study period. In 2022, late adolescents (15-19 years) had the highest rate of skateboard injuries (43.84), early adolescents (10-14 years) led in scooter-related injuries (32.01), and young adults (20-24 years) were most affected by e-scooter injuries, with a rate of 6.19 per 100,000 individuals. During the study period, 115,783 fractures were recorded for skateboard (56,632), scooter (56,607), and e-scooter (2544) injuries across the United States. In 2022, the fracture rates were 35.39 for skateboards, 35.21 for scooters, and 34.33 for e-scooters per 100 vehicle injuries. Forearm fractures were the most common injury type across all vehicles. In 2022, large states reported the highest number of injuries, with New York leading in e-scooter injuries (381) and California topping both skateboard (1066) and scooter injuries (827), highlighting geographic disparities. E-scooter injuries exhibited a 1310 % increase from 2020 to 2022, underscoring this rising public health burden.

CONCLUSIONS: Skateboards are the leading cause of vehicle-related injuries and fractures. Injury demographics are shifting, with e-scooters affecting a broader, older population, but males remain the most affected group across all vehicle types.

LEVEL OF EVIDENCE: Level III.

PMID:40328080 | DOI:10.1016/j.injury.2025.112361

Injury. 2025 Apr 29;56(7):112357. doi: 10.1016/j.injury.2025.112357. Online ahead of print.

ABSTRACT

Heterotopic ossification (HO) is a frequent complication following spinal cord injury (SCI), yet evidence regarding the efficacy of bisphosphonates in managing this condition remains limited. This systematic review aims to evaluate the role of bisphosphonates in the prevention and treatment of HO in patients with SCI. A comprehensive search of PubMed, CINAHL, ScienceDirect, Cochrane Library, and the Centre for Reviews and Dissemination databases was conducted to identify studies meeting predefined inclusion criteria. Relevant articles were also identified through bibliographic references. A total of 11 studies were included: nine investigating etidronate, one on alendronate, and one on pamidronate. Bisphosphonate administration varied, with oral etidronate provided for a minimum of 12 weeks and intravenous pamidronate given for up to 14 days. Bisphosphonates were used either prophylactically or therapeutically to delay the progression of HO. Findings across all studies highlighted the preventive role of bisphosphonates in reducing the occurrence of HO in SCI patients and demonstrated their therapeutic potential, as evidenced by less extensive heterotopic bone formation. However, the available evidence remains insufficient to draw definitive conclusions about the optimal use of bisphosphonates in this population. Further well-designed clinical trials are required to elucidate their preventive and therapeutic efficacy in managing HO after SCI.

PMID:40328079 | DOI:10.1016/j.injury.2025.112357

Int Orthop. 2025 May 7. doi: 10.1007/s00264-025-06460-0. Online ahead of print.

ABSTRACT

PURPOSE: In this study we aimed to identify the impact of the weekend effect on complications in patients undergoing total joint arthroplasty (TJA) including total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the United States.

METHODS: This study is a retrospective cohort study including patients who underwent total joint arthroplasty (i.e. TKA and THA) from 2010 to 2022 across the United States. Patient records were queried from PearlDiver. The 90-days surgical outcomes were compared between patients who had the surgery on weekends and those who underwent the operation on a weekdays.

RESULTS: The study consisted of 2,208,713 patients who underwent TJA; 1,374,018 and 834,695 with TKA and THA, respectively. Ninety-days' incidences of peri-prosthetic joint infection, implant loosening, pneumonia, sepsis, and readmission were higher after TKA surgeries performed on weekends compared to weekdays (OR (95%CI): 4.20 (3.25, 5.44), 2.62 (1.06, 6.45), 1.65 (1.11, 2.43), 3.65 (2.51, 5.29), and 3.14 (2.74, 3.61), respectively). As for THA surgeries, 90 days' incidence of per-prosthetic joint infection, peri-prosthetic fracture, acute renal failure, respiratory failure, sepsis, systemic complications, and readmission were higher among surgeries performed on weekends (OR (95%CI): 4.61 (3.63, 5.85), 2.00 (1.41, 2.83), 1.60 (1.21, 2.11), 1.73 (1.15, 2.60), 2.61 (1.86, 3.67), 1.21 (1.06, 1.39), and 4.12 (3.61, 4.71), respectively).

CONCLUSIONS: TJAs performed on weekends carry higher risk of post-operative complications and poor surgical outcomes. Also, patients undergoing TJA on weekends have a higher prevalence of pre-existing risk factors and poorer baseline health conditions. Findings from this study suggest that access to adequate physical therapy and a rehabilitation centre staffed with skilled nurses on a seven day basis could mitigate complications in patients undergoing TJA during the weekends. Furthermore, high-risk patients should undergo their procedures when hospitals are most well-prepared.

PMID:40329015 | DOI:10.1007/s00264-025-06460-0

Injury. 2025 Apr 28:112363. doi: 10.1016/j.injury.2025.112363. Online ahead of print.

NO ABSTRACT

PMID:40320354 | DOI:10.1016/j.injury.2025.112363

Injury. 2025 Apr 29;56(7):112369. doi: 10.1016/j.injury.2025.112369. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the association of safe firearm storage and reduced risk of injury and death, many children live in homes with unsecured firearms. The Child Opportunity Index (COI) assesses neighborhood resources that impact health; lower COI levels have been linked to higher rates of firearm-related injuries. This study examined the relationship between COI and firearm ownership and storage practices.

METHODS: This was a cross-sectional survey study that took place between November 2022 and October 2023 in two geographically separate Level 1 Emergency Departments in Texas. English and Spanish speaking patients assigned triage acuity levels of 3, 4, or 5 were included, and survey questions were derived from the National Health Interview Survey to examine firearm injury ownership and storage practices.

RESULTS: 4,248 patient families were approached, with 2,882 (68 %) participating. 690 (23.9 %) self-reported as firearm owners, 541(78.4 %) reported storing guns locked and 392(56.8 %) reported keeping the firearm unloaded. Over half (50.4 %) of respondents were in the very low (692) or low COI (750) quintiles. Participants in the very high COI levels were associated with a higher risk of living in a home with firearms compared with those in the very low COI levels (very high COI RR 1.81, p < 0.001, 95 % CI [1.39, 2.37]). There was no association between a respondent's COI level and the method or rates of firearm storage.

DISCUSSION AND CONCLUSIONS: While children in higher COI quintiles were more likely to live in homes with firearms, storage practices are suboptimal across all COI quintiles. Future work should focus on creating effective and consistent messaging on the importance of firearm storage practices across individuals in all COI quintiles.

PMID:40319572 | DOI:10.1016/j.injury.2025.112369

Injury. 2025 May 2;56(7):112360. doi: 10.1016/j.injury.2025.112360. Online ahead of print.

ABSTRACT

Distal radius fractures are common injuries often requiring surgical intervention for effective management. This study compares the biomechanical stability of two osteosynthesis configurations using a palmar locking plate with either four or two epiphyseal screws for extra-articular distal radius fractures. Finite element analysis (FEA) was performed on nine antomical radius models to evaluate displacement, axial stiffness, peri‑implant stresses, and fracture risk using the Mohr-Coulomb criterion. Results demonstrated minimal differences in displacement between the two groups, with both configurations maintaining acceptable levels of stability under a 250 N load. Assemblies with four screws exhibited slightly higher axial stiffness (average 4362 N/mm) compared to two screws (average 3080 N/mm). Peri-implant stresses were generally higher in the two-screw models, yet remained within tolerable ranges. This study is the first to analyze a two-epiphyseal screw configuration, offering insight into the feasibility of reducing screw count without compromising stability. Potential benefits include fewer surgical complications, reduced material use, and lower costs. However, limitations such as the small sample size, simplified loading conditions, and absence of osteodensitometry warrant further experimental validation. The findings suggest that a two-epiphyseal screw assembly could serve as an effective alternative for distal radius fracture management, supporting its potential integration into clinical practice following experimental corroboration.

PMID:40318434 | DOI:10.1016/j.injury.2025.112360

Injury. 2025 Apr 27;56(7):112362. doi: 10.1016/j.injury.2025.112362. Online ahead of print.

ABSTRACT

BACKGROUND: The KNEE Study is a prospective multicentre service evaluation examining the current UK management of fragility fractures around the knee. It aims to describe operative decision making, causes of treatment delays, weight-bearing strategies, and post-operative management.

METHODS: Data were prospectively collected across a 4-month period via a collaborative approach. All patients aged >60 with a fracture of the proximal tibia or distal femur were included. Data collected include injury classification, operative vs non-operative management, time to theatre, post-operative weight bearing, and post-operative optimisation as per BOAST guidelines for frail older patients.

RESULTS: Data were available for 459 patients across 39 centres. This included 252 distal femoral fractures, and 207 proximal tibial fractures. Distal femoral fractures were significantly older (81.5 vs 73.3), had poorer mobility (42 % mobile ≤1 stick vs 79 %), and were more comorbid (median charlson co-morbidity index 5 vs 3) than proximal tibial fractures. Operative management was undertaken in 292/459 cases (198/252 femur, 94/207 tibia). When operative management was undertaken, there was a delay >36 hours to theatre in 62.8 % of cases. The main reasons for this were theatre capacity (42.6 %) and availability of a specialist surgeon (25.1 %). Only 11.5 % of cases were delayed pending medical optimisation or anticoagulant reversal. Patients managed operatively were significantly more likely to weight-bear on the first day post treatment (69.5 % vs 55.8 %). Operatively managed patients were significantly more likely to receive post-operative standards of care including Geriatric review, physio assessment, and bone health assessment.

CONCLUSION: Early return to weight bearing and ongoing secondary prevention are core tenants in the management of fragility fractures. Management of fragility fractures around the knee continues to lag behind that of hip fractures, with lower rates of weight bearing, slower access to theatre, and poorer post-operative care.

PMID:40318433 | DOI:10.1016/j.injury.2025.112362

Int Orthop. 2025 May 3. doi: 10.1007/s00264-025-06548-7. Online ahead of print.

ABSTRACT

PURPOSE: This study was performed to analyse the clinical factors associated with failure of nano-hydroxyapatite/polyamide 66 (nHA/PA66) bracing rods combined with allogeneic bone in the treatment of early-stage osteonecrosis of the femoral head (ONFH).

METHODS: In total, 96 patients were treated with nHA/PA66 bracing rods combined with allogeneic bone for ONFH between October 2016 and September 2020. The patients were classified according to aetiology, Association Research Circulation Osseous (ARCO) type, Japanese Investigation Committee (JIC) type, age, and body mass index(BMI). The outcome measures were the Hip Harris Score (HHS), imaging changes, and the need for total hip arthroplasty (THA) (performed in cases of clinical failure, at which point follow-up was discontinued).

RESULTS: All patients were included in the study, with a mean follow-up duration of 50.76 ± 17.94 months. The preoperative HHS was 79.00 ± 13.61 and that at the final follow-up was 81.73 ± 17.67(P = 0.149). The excellent and good rate improved from 43.88% preoperatively to 65.47% at the final follow-up(P = 0.000). The radiographic progression rate was 36.70% and the incidence of THA was 23.02%. Univariate analysis identified ARCO type (P = 0.000), JIC type (P = 0.000), and age (P = 0.003) as independent risk factors for postoperative failure. Postoperative multivariate analysis also confirmed ARCO type, JIC classification, and age as risk factors.

CONCLUSION: This technique is not recommended for patients older than 44 years or those with ARCO type 3 or JIC type C ONFH.

PMID:40317313 | DOI:10.1007/s00264-025-06548-7

Injury. 2025 Apr 23:112330. doi: 10.1016/j.injury.2025.112330. Online ahead of print.

ABSTRACT

BACKGROUND: Patients surviving major traumatic injury involving the chest wall experience unpredictable recovery trajectories, typically extending over 12 months or more. While some recover well, others experience ongoing physical and mental health difficulties and reduced quality of life. A nuanced understanding of the meaning and process of recovery is needed to inform the development of interventions to enable patients to access the right help, at the right time. Hence, we examined the experience of recovery and the bio-psycho-social factors shaping recovery in the months after traumatic injury resulting in admission to intensive care.

METHODS: This qualitative inquiry was underpinned by philosophical pragmatism, an approach which promotes development of knowledge that can be applied to solve problems. Participants recruited from a tertiary hospital completed semi-structured interviews encompassing perceived recovery, health as reflected in the EQ-5D-5 L, and factors influencing recovery. Qualitative data were analysed using the framework approach enabling the team to focus on matters pertinent to participants while addressing research questions. EQ-5D-5 L data were analysed descriptively.

RESULTS: Fourteen participants including 13 men, aged 19 to 67 years were interviewed by telephone, video-conference or in-person four- to seven-months post-injury. Duration of interviews was, on average, 50 min. Participants understood recovery as a non-linear process with progress assessed against pre-injury 'normal'; some acknowledged the need to develop and adapt to a new 'normal'. Engagement in the recovery process ranged along a spectrum anchored by passivity and proactivity, with approach taken reflecting the participant's characteristic way of being, and investment in a 'reason to recover'. Recovery was a function of interlinked factors categorised as 'pre-injury life circumstances', 'recovery mindset', 'recovery behaviours' and 'recovery resources'. While EQ-5D-5 L scores indicated substantial impairment across domains, participants generally regarded themselves as recovering well 'given the circumstances'.

CONCLUSIONS: Findings highlight the need for care to be grounded in an appreciation of the 'person' of the patient because pre-injury circumstances inexorably shape approach to recovery, engagement in recovery behaviours and access to resources. The model of recovery developed in this study can guide clinicians undertaking the comprehensive assessment that is fundamental to provision of personalised care, and ongoing evaluation of recovery, potentially using patient-generated outcome measures.

PMID:40312173 | DOI:10.1016/j.injury.2025.112330

Injury. 2025 Apr 15;56(6):112333. doi: 10.1016/j.injury.2025.112333. Online ahead of print.

ABSTRACT

Trauma accounts for around 4.4 million deaths annually and is among the leading causes of death, disproportionately affecting low- and middle-income countries. Trauma quality improvement programmes may reduce adverse patient outcomes but lack robust evidence. This study assessed the effect of implementing a trauma quality improvement programme using audit filters on health-related quality of life in adult trauma patients in urban India. We conducted a controlled interrupted time series study (ClinicalTrials.gov ID NCT03235388) across four tertiary care university hospitals. Adult (≥18 years) trauma patients, who were alive at 90 days post-admission, were included. After a 14-month observation phase, two hospitals were randomized to the intervention arm and implemented the trauma quality improvement programme, while two control hospitals did not implement any interventions. The study spanned from 2017 to 2022. Health-related quality of life was assessed 90 days post-admission using the EuroQol 5-dimensions (EQ-5D) questionnaire. The main outcome was EQ-5D health status, scaled from 0 to 100, analyzed using a difference-in-differences (DiD) approach. Descriptive analysis was performed for the five individual EQ-5D dimensions. 2307 participants were eligible for the analyses. The DiD analysis showed a statistically significant reduction in the EQ-5D health status score in the intervention arm (DiD estimate -4.07 [95 % CI:-7.00; -1.15]). For the 819 patients with major trauma, there was a more pronounced, but statistically non-significant reduction (DiD estimate -4.86 [95 % CI:-9.87; 0.15]). In the intervention arm, mobility, self-care, and pain/discomfort improved, while usual activities and anxiety/depression worsened. Implementing trauma quality improvement programmes using audit filters may reduce the average health-related quality of life of trauma patients if more severely injured patients survive, highlighting the importance of assessing quality of life after the implementation of such programmes and ensuring adequate rehabilitation resources to support long-term recovery.

PMID:40311153 | DOI:10.1016/j.injury.2025.112333

J Bone Joint Surg Am. 2024 Sep 18;106(18):1725-1730. doi: 10.2106/JBJS.24.00060. Epub 2024 May 30.

NO ABSTRACT

PMID:40305841 | DOI:10.2106/JBJS.24.00060

J Bone Joint Surg Am. 2024 Nov 20;106(22):e47. doi: 10.2106/JBJS.24.00716. Epub 2024 Nov 20.

NO ABSTRACT

PMID:40305836 | DOI:10.2106/JBJS.24.00716

J Bone Joint Surg Am. 2024 Aug 7;106(15):e33. doi: 10.2106/JBJS.24.00400. Epub 2024 Aug 7.

NO ABSTRACT

PMID:40305835 | DOI:10.2106/JBJS.24.00400

J Bone Joint Surg Am. 2024 Aug 7;106(15):e32. doi: 10.2106/JBJS.24.00419. Epub 2024 Aug 7.

NO ABSTRACT

PMID:40305834 | DOI:10.2106/JBJS.24.00419

J Bone Joint Surg Am. 2024 Aug 7;106(15):e31. doi: 10.2106/JBJS.24.00493. Epub 2024 Aug 7.

NO ABSTRACT

PMID:40305833 | DOI:10.2106/JBJS.24.00493

J Bone Joint Surg Am. 2024 Aug 7;106(15):1384-1394. doi: 10.2106/JBJS.23.01203. Epub 2024 Jun 5.

ABSTRACT

BACKGROUND: This study aimed to identify implant positioning parameters and patient factors contributing to acromial stress fractures (ASFs) and scapular spine stress fractures (SSFs) following reverse shoulder arthroplasty (RSA).

METHODS: In a multicenter retrospective study, the cases of patients who underwent RSA from June 2013 to May 2019 and had a minimum 3-month follow-up were reviewed. The study involved 24 surgeons, from 15 U.S. institutions, who were members of the American Shoulder and Elbow Surgeons (ASES). Study parameters were defined through the Delphi method, requiring 75% agreement among surgeons for consensus. Multivariable logistic regression identified factors linked to ASFs and SSFs. Radiographic data, including the lateralization shoulder angle (LSA), distalization shoulder angle (DSA), and lateral humeral offset (LHO), were collected in a 2:1 control-to-fracture ratio and analyzed to evaluate their association with ASFs/SSFs.

RESULTS: Among 6,320 patients, the overall stress fracture rate was 3.8% (180 ASFs [2.8%] and 59 SSFs [0.9%]). ASF risk factors included inflammatory arthritis (odds ratio [OR] = 2.29, p < 0.001), a massive rotator cuff tear (OR = 2.05, p = 0.010), osteoporosis (OR = 2.00, p < 0.001), prior shoulder surgery (OR = 1.82, p < 0.001), cuff tear arthropathy (OR = 1.76, p = 0.002), female sex (OR = 1.74, p = 0.003), older age (OR = 1.02, p = 0.018), and greater total glenoid lateral offset (OR = 1.06, p = 0.025). Revision surgery (versus primary surgery) was associated with a reduced ASF risk (OR = 0.38, p = 0.019). SSF risk factors included female sex (OR = 2.45, p = 0.009), rotator cuff disease (OR = 2.36, p = 0.003), osteoporosis (OR = 2.18, p = 0.009), and inflammatory arthritis (OR = 2.04, p = 0.024). Radiographic analysis of propensity score-matched patients showed that a greater increase in the LSA (ΔLSA) from preoperatively to postoperatively (OR = 1.42, p = 0.005) and a greater postoperative LSA (OR = 1.76, p = 0.009) increased stress fracture risk, while increased LHO (OR = 0.74, p = 0.031) reduced it. Distalization (ΔDSA and postoperative DSA) showed no significant association with stress fracture prevalence.

CONCLUSIONS: Patient factors associated with poor bone density and rotator cuff deficiency appear to be the strongest predictors of ASFs and SSFs after RSA. Final implant positioning, to a lesser degree, may also affect ASF and SSF prevalence in at-risk patients, as increased humeral lateralization was found to be associated with lower fracture rates whereas excessive glenoid-sided and global lateralization were associated with higher fracture rates.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40305832 | DOI:10.2106/JBJS.23.01203