Shoulder Arthroplasty Research Committee (ShARC)

With more than 80 publications, ShARC research has made a significant impact in refining procedural techniques and driving medical innovation for shoulder arthroplasty. Through the global collaboration of over 35 contributors, our research has provided new findings on key topics, including glenoid lateralization, subcoracoid distance, and reducing acromial stress fractures. Our research findings have shown that a well-designed reverse shoulder prosthesis should ensure glenoid lateralization and position the glenosphere at the inferior border of the glenoid. This approach helps reduce distalization and the risk of acromial stress fractures. By prioritizing principles such as minimal overhang, increased subcoracoid distance, and optimal lateralization, we can enhance deltoid function and minimize scapular notching. These refined strategies aim to improve both function and patient outcomes, and they will continue to be central to our commitment to advancing surgical results and improving patient outcomes. Thank you to all our members for transforming clinical data and theoretical approaches into real-world solutions that improve patient outcomes. We look forward to sharing the latest ShARC research updates and publications. View our complete publications list: https://lnkd.in/dd6wyXVM What research topic would you like to see from ShARC in 2025? Comment below. #Innovation #ShoulderArthroplasty #Research #PatientOutcomes Featured Articles: The subcoracoid distance is correlated with pain and internal rotation after reverse shoulder arthroplasty - https://lnkd.in/d_6wCHZS Quantifying bone loss and lateralization with standardized vs augmented baseplates - https://lnkd.in/dxUtm227 Up to 8 mm of glenoid-sided lateralization does not increase the risk of acromial or scapular spine stress fracture - https://lnkd.in/d6YWN85w A stemless anatomic shoulder arthroplasty design provides increased cortical media calcar bone loading in variable bone densities - https://lnkd.in/dKF5mVqx

The use of reverse shoulder arthroplasty (RSA) for various shoulder pathologies is increasingly common. There is conflicting evidence in the literature for the role that a patient’s age has on outcomes. The recent study “Reverse Shoulder Arthroplasty Patients Younger Than 60 Years Old Exhibit Lower Clinically Significant Single Assessment Numeric Evaluation (SANE) Scores Compared to Older Patients“ by Brendan P. Stewart, MD; Benjamin Hawthorne, MD; Caitlin G. Dorsey, BS; Ian J. Wellington, MD; Mark Cote, DPT; and Augustus Mazzocca MD, further investigates this topic by comparing Single Assessment Numeric Evaluation (SANE) scores between different age groups of patients undergoing RSA. Key takeaways: ✅ Retrospective clinical study of 292 patients ✅ 39 patients <60 years old, 115 between 60-69 years, 115 between 70-79 years, and 23 older than 80 years ✅ The patients less than 60 years old had a higher percentage of prior surgeries, higher smoking rates, and more worker compensation claims. ✅ At 2 years follow-up, a lower proportion of patients younger than 60 years undergoing RSA achieved clinically significant postoperative SANE scores. This study demonstrates that younger patients tend to present with more confounding factors before RSA – failed prior surgeries, workers compensation claims, and smoking. Despite a lower proportion of patients younger than 60 years reaching clinically significant postoperative SANE scores, they did on average improve from scores of 30 preoperatively to 70 postoperatively. Further research is needed with the younger patient cohort to identify optimal implant characteristics for function and control for all confounding variables. Do you have an age cut-off for indicating a reverse shoulder arthroplasty? If so, how do you manage these patients with irreparable rotator cuff tears or prior failures? Comment Below: #Innovation #ShoulderArthroplasty #Research #PatientOutcomes

What is your acceptable backside contact before you change from a standard baseplate to an augment? A common debate has been how to identify the threshold of backside contact for baseplate stability. Over the past decade, CT-based 3D models of the preoperative shoulder have become an integral part of preoperative arthroplasty planning. The study “Influence of Backside Seating Parameters and Augmented Baseplate Components in Virtual Planning for Reverse Shoulder Arthroplasty” published in Journal of Shoulder and Elbow Surgery (JSES) by Brian Werner, MD; Albert Lin, MD; Tim Lenters, MD; David Lutton, MD; R. Alexander Creighton, MD; Joshua Port, MD; Scott Doody; Nick Metcalfe; and David Knopf uses data from “virtual planning software” or “preoperative arthroplasty planning software” to explore the influence of a backside seating percentage on contact area and volume of reamed bone for reverse total shoulder arthroplasty (rTSA). A secondary goal was to evaluate the impact of the option of augmented baseplates on these variables. Study Breakdown: Nine surgeons plan 30 rTSAs using virtual implant positioning software. Phase 1—cases planned with standard MGS baseplate blinded to backside seating %; phase 2—cases planned with backside seating %; phase 3—cases planned with % and augmented baseplates Data Interpretation: CAD models—the total volume of bone reamed, including % cortical and cancellous. Total baseplate contact (cortical/cancellous) and lateralization compared Results: Version and inclination were similar overall but statistically lower in phase 3. Phase 3 showed lower cancellous and total reamed bone and significantly larger cortical contact area and total contact area. Key Takeaways: Experienced shoulder surgeons frequently chose augmented baseplates, resulting in greater correction, improved total and cortical contact area, less bone loss, and increased glenoid lateralization. Blinding to backside seating percentage does not have a significant impact on correction, planned contact area, or volume of reamed bone. Read the full study: https://lnkd.in/eFvE66Kd Does autografting the glenoid or even the potential availability of a patient-specific implant change your treatment plan? Comment below. #Innovation #ShoulderArthroplasty #Research #PatientOutcomes

Do you tell patients that an elevated body mass index (BMI) can affect their outcome after reverse shoulder arthroplasty (RSA)? While obesity has often been associated with increased complications after joint arthroplasty, numerous studies have demonstrated improved functional outcomes and satisfaction among patients with a BMI >30. As such, the role of obesity as an independent risk factor for heightened complications continues to generate debate. In the current study, performed by Anup Shah, MD; Youssef Galal, BS; Brian C. Werner, MD; Reuben Gobezie, MD; Patrick J. Denard, MD; and Evan Lederman, MD, titled “Obesity is associated with improvement in functional outcome but lower internal rotation after reverse shoulder arthroplasty,” obese patients had significantly lower ASES and WOOS scores as well as less external rotation and internal rotation (IR) at baseline compared to their matched cohort. However, 2 years after undergoing RSA, there were no statistical differences in their patient-reported outcomes, range of motion, or strength, other than one spine-level difference in IR. This study shows that the RSA procedure does not need to be restricted solely based on BMI. While obesity may not be an independent risk factor for complications in RSA patients, counseling these patients is imperative given the often-associated comorbidities that may adversely affect their outcomes. Read the full study: https://lnkd.in/d_6PCp4v #Innovation #ShoulderArthroplasty #Research #PatientOutcomes

How do you address your B2 glenoid deformity with shoulder replacement? When do you high-side ream? What measurements and deformity prompt you to use an augmented glenoid component or reverse shoulder arthroplasty? The biconcave (See B2 in the attached image) glenoid is a challenging morphology for reconstruction in shoulder arthroplasty. An additional challenge is the variability among B2 glenoids based on the severity of posterior wear, size of the neoglenoid, and associated posterior humeral head subluxation, which may have important treatment implications. Milder deformities have often been addressed with an anatomic arthroplasty and reaming. Moderate deformities are sometimes addressed with an anatomic augmented glenoid component, while more severe deformities may be addressed with reverse arthroplasty. The assessment of overall glenoid retroversion, neoglenoid retroversion, and of the paleo and neoglenoid, as well as characterizing the severity of posterior humeral head subluxation, can be time-consuming in the clinic and have poor inter-rater reliability between surgeons. Accordingly, the purpose of this study was to evaluate a new and simple measure (critical B2 ratio) or paleoglenoid length relative to the overall glenoid length on axial computed tomography images to determine if a threshold could be defined to help guide the treatment plan. This study was performed by Sameer R. Oak, MD; Jeffrey L. Horinek, MD; Laurel A. Barras, MD; Bruce S. Miller, MD; Brian C. Werner, MD; Patrick J. Denard, MD; and Asheesh Bedi, MD, and recently published in the Journal of Shoulder and Elbow Surgery (JSES) Seminars in Arthroplasty. The authors found the critical B2 ratio to be easy to measure with high inter- and intra-rater reliability among shoulder surgeons. They found a significant correlation between glenoid bone loss along Friedman’s line and the critical B2 ratio (P < .001), and ROC curves found a B2 ratio ≤ 0.4 was an inflection point for 15° of neoglenoid (posterior erosion surface) retroversion. This study suggests that a critical B2 ratio ≤ 0.4 correlates with significant neoglenoid retroversion and may be used as a simple “rule of thumb measurement” beyond which to exercise caution with corrective eccentric reaming for anatomic shoulder arthroplasty. The authors are now using this in the clinic to prospectively validate its role in implant selection and deformity correction with shoulder replacement. Read the full study: https://lnkd.in/eV3uVtcv Would you use this ratio to help you in decision-making for B2 glenoids? Comment below. #Innovation #ShoulderArthroplasty #Research #PatientOutcomes

During the American Shoulder and Elbow Surgeons Annual Meeting (ASES), the ShARC hosted leading surgeons from around the world both virtually and in person for one of our quarterly meetings to discuss and collaborate on innovative ongoing and future studies on topics such as: -Influence of Glenoid SSM on RSA Planning -3D Measurements of Glenoid Position and ROM after RSA -Scapular Notching and Glenoid-Sided Lateralization in RSA -Influence of Preop Humeral Head Morphology on Postoperative Outcomes following TSA Thank you to everyone who joined us! We look forward to our next meeting as we continue driving the future of shoulder arthroplasty through ShARC research. #Innovation #ShoulderArthroplasty #Research #PatientOutcomes

Do patients experience less pain with a stemless shoulder arthroplasty? At a time when reducing the use of narcotic pain medications is a key priority for prescribers, surgeons have noticed less pain after stemless anatomic total shoulder arthroplasty (aTSA) surgery compared to aTSA using stemmed components. The recently published article “Stemless anatomic total shoulder arthroplasty is associated with less early postoperative pain” by Brian C. Werner, MD; M. Tyrrell Burrus, MD; Patrick J. Denard, MD; Anthony A. Romeo, MD; Evan Lederman, Justin W. Griffin, MD; Benjamin Sears, MD; and the Shoulder Arthroplasty Research Committee (ShARC) evaluated postoperative pain levels between matched stemless and short-stem cohorts.* Key Takeaways: The study included 124 patients (62 in each cohort), all with 2-year follow-up. At 9 weeks after surgery, the stemless cohort demonstrated significantly less pain using the VAS score (1.5 vs 2.5). This finding was consistent across multiple pain scores (American Shoulder and Elbow Surgeons pain subscore, Western Ontario Osteoarthritis of the Shoulder Physical Symptoms, and Single Assessment Numeric Evaluation). Interestingly, patients in the stemless cohort were significantly more likely to be able to sleep on the affected shoulder at 9 weeks (29% vs 11%); The difference in pain and sleeping is no longer present by 26 weeks. Two years postoperatively, PROs, range of motion, and strength measures were all similar between the two cohorts. This study confirms that stemless aTSA implants result in earlier pain improvement compared to short-stem aTSA implants. Additionally, an earlier return to sleeping on the affected shoulder was seen in the stemless aTSA group. It is important to note that the stemless implant studied was the Arthrex EclipseTM device, which relies on cortical rim support and cage-screw compression. A similar study using an impaction-style stemless implant did not identify a difference in postoperative pain levels. Further studies are needed to determine if the improved pain levels are associated with the Eclipse implant. Do the results of this study resemble what other surgeons are seeing clinically? Are there any reasonable hypotheses as to why the pain may be less with stemless devices? Less blood loss? Less soft-tissue trauma and swelling due to reduced OR time? Less bony trauma since there’s no broaching the canal? Comment below: #Innovation #ShoulderArthroplasty #Research #PatientOutcomes *Werner BC, et al. Stemless anatomic total shoulder arthroplasty is associated with less early postoperative pain. JSES Int. 2023;8(1):197-203. doi: 10.1016/j.jseint.2023.10.012

Do you use patient-specific instrumentation (PSI) in all cases, in difficult cases, or not at all? CT-based virtual preoperative planning with PSI is increasingly used to precisely execute shoulder arthroplasty position and orientation. Moreover, the hope is to achieve improvement in long-term clinical outcomes. In the study, “Short-term functional outcomes of reverse shoulder arthroplasty following three-dimensional planning is similar whether placed with a standard guide or patient-specific instrumentation,” the authors compared rTSA outcomes between patients receiving an rTSA with a reusable PSI guide and patients with standard instrumentation in a retrospective matched comparison of a multicentric prospective cohort.* Takeaways: 3D planning or 3D planning with PSI techniques led to similar improvement in patient-reported outcome measurements at short-term follow-up. Cases performed with PSI showed better abduction strength and external rotation strength but lower internal rotation. This is likely explained by a confounder as this patient cohort had less glenoid-sided lateralization than the cohort of patients with standard instrumentation. In summary, if 3D planning is used preoperatively, short-term outcomes following rTSA are similar whether PSI or a standard guide is used. However, two important factors should be considered when interpreting this data. First, because there was no assessment of implant position postoperatively, outcomes may vary in long-term follow-up. Second, all cases in this series were performed by high-volume surgeons with experience in planning, so the lack of differences may not be generalizable. Thus, there appears to be no downside to the use of PSI if cost considerations are eliminated with a reusable guide, but longer-term follow-up may be needed to detect differences in functional outcomes. What is your experience with PSI? Are associated costs limiting your usage rate of this technology? Would humeral-sided PSI be helpful as well? #Innovation #ShoulderArthroplasty #Research #PatientOutcomes *Hwang S, Werner BC, Provencher M, et al. Short-term functional outcomes of reverse shoulder arthroplasty following three-dimensional planning is similar whether placed with a standard guide or patient-specific instrumentation. J Shoulder Elbow Surg. 2023;32(8):1654-1661. doi: 10.1016/j.jse.2023.02.136

In case you missed it: Arthrex is honored to share that former Major League Baseball (MLB) pitcher Dave Dravecky and orthopedic surgeon Michael Kissenberth, MD, recently appeared on WCCP 105.5 FM The Roar with host Mickey Plyler to discuss our innovative Eclipse™ Total Shoulder Arthroplasty System. Just over three years ago, Dravecky, a cancer survivor and amputee, underwent a total shoulder replacement performed by Sam Harmsen, MD, with Arthrex's groundbreaking technology, significantly enhancing his quality of life. Listen to Dravecky’s inspiring story and hear Dr. Kissenberth discuss the key features of Arthrex shoulder arthroplasty innovation and its role in restoring mobility and function for patients: https://lnkd.in/ebC5JQaG #MedicalEducation #Innovation #Eclipse #Arthroplasty #ShoulderReplacement

Have you seen subacromial notching in your practice? Subacromial notching is a reverse total shoulder arthroplasty complication that occurs when the humerus impinges against the lateral acromion in abduction. Subacromial notchings are less known than scapular notchings, which are commonly found with medialized designs. A recent study published in JSES International by Theresa Pak, DO; Mariano E. Menendez, MD; Reuben Gobezie, MD, MD; Benjamin Sears, MD; Evan Lederman, MD, MD; Shoulder Arthroplasty Research Committee (ShARC) group; Brian Werner, MD; and Patrick Denard, MD, evaluates the incidence of subacromial notching with a 135° inlay humeral component and determines whether specific patient characteristics or prosthesis properties, such as component lateralization, may play a role. Key Takeaways: This was a retrospective study of prospectively collected data of 442 patients with a minimum 1-year follow-up. All were 135° inlay humeral implants. Subacromial notching was an uncommon occurrence, noted in only 13 patients (2.9%). Among the patient characteristics evaluated, age, sex, BMI, and hand dominance had no impact on the development of notching. Neither lateralization of the glenoid nor humeral offset was associated with subacromial notching. The presence of notching did not impact ASES scores. Despite concerns raised in some biomechanical studies about prosthesis lateralization contributing to abduction impingement, this study did not note any correlation between the amount of lateralization and subacromial impingement. It needs to be emphasized that subacromial notching with a 135° humeral implant is rare and seems to have no impact on patient outcomes. However, this study only reported on 1-year outcomes, so long-term follow-up is required to see what impact, if any, subacromial notching may have. Read the full study: https://lnkd.in/e_aWddPn Have you noticed any subacromial notching and/or an impact on functional outcomes in your practice? If so, what type of implant do you use? Comment below. #Innovation #ShoulderArthroplasty #Research #PatientOutcomes