Showing papers by "Bradford O. Parsons published in 2019"

Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears: A Systematic Review.

Abstract: Purpose To evaluate the preliminary clinical outcomes and complications of superior capsule reconstruction (SCR) for irreparable rotator cuff tears. Methods A systematic review of PubMed, MEDLINE, EMBASE, and Cochrane databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical outcomes of irreparable rotator cuff tears managed by SCR were included. Clinical outcome analyses of pre- and postoperative range of motion, American Shoulder and Elbow Surgeons scores, visual analog scale pain scores, and acromiohumeral intervals (AHIs) were performed and reported as range or frequency. Results Five studies (285 patients, 291 shoulders) of level III-IV evidence were included, with a weighted mean (± standard deviation) follow-up of 27.7 ± 17.3 months. Forward flexion improved from 91°-130° preoperatively to 147°-160° postoperatively, external rotation from 26°-41° to 41°-45°, and internal rotation from L4-L1 to L1. American Shoulder and Elbow Surgeons scores increased from 36-52.2 to 77.5-92, and visual analog scale pain scores decreased from 4.0-6.3 to 0.4-1.7. Radiographically, AHIs with acellular dermal allograft ranged from 4.5 to 7.1 mm preoperatively, improving to 7.6-10.8 mm immediately postoperation before decreasing to 6.7-9.7 mm by final follow-up. Complication and graft failure rates were 17.2% and 11.7%, respectively. Conclusions Preliminary results of SCR show consistent improvement in shoulder functionality and pain reduction. However, a decrease in postoperative AHIs indicates dermal allograft elongation and persistent superior migration of the humerus, potentially contributing to later graft failure. Studies with longer follow-up will be essential to evaluate the long-term utility of SCR in the treatment of irreparable rotator cuff tears. Level of Evidence Level IV, systematic review of level III-IV studies.

Drain Use is Associated with Increased Odds of Blood Transfusion in Total Shoulder Arthroplasty: A Population-Based Study.

Abstract: BACKGROUND In the absence of evidence supporting its benefit, the American Academy of Orthopaedic Surgeons (AAOS) strongly recommends against closed wound drainage in TKA; however, drain usage remains common in other joints, including the shoulder. While an extensive body of research exists for drain use in lower extremity joint arthroplasty, large-scale data on drain use and its association with benefits and complications in shoulder arthroplasties is lacking. Such data may be particularly valuable given the rapidly increasing demand for shoulder arthroplasties. QUESTION/PURPOSE Using national claims data, we (1) evaluated the trends in frequency of drain usage in shoulder arthroplasty procedures over time, as well as the association between drain usage and (2) blood transfusion usage, (3) length of stay (LOS), and (4) readmission or early infection within 30 days. METHODS This retrospective study used data from the nationwide Premier Healthcare claims database (2006-2016; n = 105,116, including total, reverse, and partial shoulder arthroplasties, in which drains were used in 20% [20,886] and no drain was used in 80% [84,230]). Included hospitals were mainly concentrated in the South (approximately 40%) with equal distributions among the Northeast, West, and Midwest (approximately 20% each). The Premier database contains detailed inpatient billing data on approximately 20% to 25% of US hospital discharges, which allows the creation of a variable indicating drain use by evaluating inpatient billing for drains. Baseline demographics differed minimally between patients receiving a drain compared with those who did not, with a median age of 70 years in both groups. The potential for selection bias was addressed by adjusting for measured confounders in mixed-effects models that estimated associations between drain use and blood transfusion usage, LOS, and readmission or (early) infection within 30 days. In addition, alternative statistical approaches were applied to address confounding, including propensity score analysis and instrumental variable analysis where a so-called "instrumental variable" is applied that mimics the treatment assignment process similar to a randomized study. We report odds ratios (OR; or % change for continuous variables) and 95% confidence intervals (CIs). RESULTS The usage of drains decreased over time, from 1106 of 4503 (25%) in 2006 to 2278 of 14,501 (16%) in 2016. After adjusting for relevant covariates, drain use was associated with an increased usage of blood transfusions (OR, 1.49; 95% CI, 1.35-1.65; p < 0.001) while only associated with a small increase in LOS (+6%, 95% CI, +4% to +7%; p < 0.001). Drain use was not associated with increased odds for early postoperative infection or 30-day readmission. Propensity score analysis and instrumental variable analysis corroborated our main results. CONCLUSIONS Use of drains in patients undergoing shoulder arthroplasty is associated with an almost 50% increased odds for blood transfusions. Given that our findings parallel close to what is known in patients undergoing lower extremity joint arthroplasty, we believe that our results from a large national database are sufficient to discourage the routine use of drains in patients undergoing shoulder arthroplasty. LEVEL OF EVIDENCE Level III, therapeutic study.

Risk factors for and timing of adverse events after revision total shoulder arthroplasty.

Abstract: BackgroundDespite increasing rates of revision total shoulder arthroplasty (RTSA), there is a paucity of literature on optimizing perioperative outcomes. The purposes of this study were to identify...

Interobserver and intraobserver comparison of imaging glenoid morphology, glenoid version and humeral head subluxation.

Abstract: Background: Glenoid morphology, glenoid version and humeral head subluxation represent important parameters for the treating physician. The most common method of assessing glenoid morphology is the Walch classification which has only been validated with computed tomography (CT). Methods: CT images and magnetic resonance imaging (MRI) images of 25 patients were de-identified and randomized. Three reviewers assessed the images for each parameter twice. The Walch classification was assessed with a weighted kappa value. Glenoid version and humeral head subluxation were comparted with a reproducibility coefficient. Results: The Walch classification demonstrated almost perfect intraobserver agreement for MRI and CT images (k = 0.87). Weighted interobserver agreement values for the Walch classification were fair for CT and MRI (k = 0.34). The weighted reproducibility coefficient for glenoid version measured 9.13 (CI 7.16–12.60) degrees for CT and 13.44 (CI 10.54–18.55) degrees for MRI images. The weighted reproducibility coefficient for percentage of humeral head subluxation was 17.43% (CI 13.67–24.06) for CT and 18.49% (CI 14.5–25.52) for MRI images. Discussion: CT and MRI images demonstrated similar efficacy in classifying glenoid morphology, measuring glenoid version and measuring posterior humeral head subluxation. MRI can be used as an alternative to CT for measuring these parameters. Keywords Glenoid morphology, glenoid version, Walch classification, humeral head subluxation

A technique for humeral prosthesis placement in reverse total shoulder arthroplasty for fracture.

Abstract: Recent trends have illustrated the benefits of treating displaced fractures of the proximal humerus with reverse total shoulder arthroplasty. Clinical results have demonstrated reliable restoration...

Intraoperative and Postoperative Issues With Open Rotator Cuff Repair

Abstract: Open rotator cuff repair complications are relatively rare; however, the surgery still presents unique intraoperative and postoperative complication risks. Intraoperatively, surgeons need to be aware of axillary nerve injuries, excessive tendon resection, and damage to the acromion. Postoperatively, the biggest complication is stiffness. Other complications to be aware of include rotator cuff retears and failure to heal, anterosuperior escape, deltoid detachment and dehiscence, and infection and wound dehiscence.