• Clinics in Shoulder and Elbow
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• v.26 no.4
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• pp.357-365
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• 2023

Background: The purpose of this study was to evaluate the effect of concomitant open distal clavicle excision (DCE) on postoperative clinical outcomes and incidence of acromial and scapular stress fractures (ASFs) in patients with symptomatic acromioclavicular joint osteoarthritis (ACJ OA) undergoing reverse total shoulder arthroplasty (RTSA). Methods: A single-surgeon retrospective cohort study was conducted including patients who underwent primary elective RTSA with or without DCE from 2015 to 2019 with a minimum 6-month follow-up period. Shoulder active range of motion (AROM) and visual analog scale (VAS) pain were recorded preoperatively and postoperatively. ASFs and other adverse events were identified using postoperative notes and/or radiographs. Characteristics and outcomes were compared between the RTSA and RTSA-DCE groups. Results: Forty-six RTSA patients (mean age, 67.9±8.7 years; 60.9% male; mean follow-up, 24.9±16.6 months) and 70 RTSA-DCE patients (mean age, 70.2±8.9 years; 20.0% male; mean follow-up, 22.7±12.9 months) were included. There were no significant intergroup differences in rates of ASF (RTSA, 0.0% vs. RTSA-DCE, 1.4%; P=1.00), stress reactions (RTSA, 8.7% vs. RTSA-DCE, 11.4%; P=0.76), reoperation, revision, or infection (all P>0.05), or in pre-to-postoperative reduction in VAS pain (P=0.17) at latest follow-up. However, the RTSA-DCE group had greater pre-to-postoperative improvement in flexion AROM (RTSA, 43.7°±38.5° vs. RTSA-DCE, 59.5°±33.4°; P=0.03) and internal rotation (IR) AROM (P=0.02) at latest follow-up. Conclusions: Concomitant DCE in RTSA improves shoulder flexion and IR AROM, alleviates shoulder pain, and does not increase the risk of ASFs. Level of evidence: III.

• Journal of the Korean Orthopaedic Association
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• v.56 no.5
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• pp.391-397
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• 2021

Purpose: Tranexamic acid (TXA) can reduce perioperative blood loss and the frequency of blood transfusions in lower extremity surgery. On the other hand, the effects of TXA on reverse total shoulder arthroplasty (rTSA) remain undetermined. This study evaluated the efficacy of TXA on perioperative blood loss, transfusion requirements, and the change in the hemotologic index. Materials and Methods: This study evaluated patients who underwent rTSA from September 2009 to July 2020. The patients were classified into two groups. The TXA group were administered TXA intravenously and topical TXA during surgery. The non-TXA group was not administered TXA. The quantity of hemovac drainage, which represented the postoperative blood loss, transfusion requirements, and postoperative change in hemoglobin and hematocrit level, were recorded. Results: The TXA and non-TXA groups consisted of 93 and 84 patients, respectively. The preoperative demographics showed no significant differences in age (72.0±7.0 vs. 71.5±5.8, p=0.656), sex (male:female, 28:65 vs. 23:61, p=0.689) and the prevalence of hypertension and diabetes (hypertension:diabetes:both, 36:3:13 vs. 32:3:8, p=0.806) between the two groups. There were significant differences in the requirements of transfusion (0 vs. 9, p=0.001), hemovac drainage at the 1^st (98.8±61.2 ml vs. 162.7±98.8 ml, p<0.001), the 2^nd postoperative day (73.8±48.4 ml vs. 91.5±54.5 ml, p=0.024), hemoglobin level at the 1^st (11.7±1.2 g/dl vs. 11.2±1.4 g/dl, p=0.048), 3^rd (10.9±1.2 g/dl vs. 10.2±1.2 g/dl, p<0.001), and 6^th (11.2±1.3 g/dl vs. 10.7±1.3 g/dl, p=0.020) postoperative day, and the hematocrit level at the 1^st (35.0%±3.6% vs. 32.5%±3.8%, p=0.001), 3^rd (32.3%±5.0% vs. 29.8%±3.6%, p<0.001), and 6^th (33.5%±3.8% vs. 31.5%±3.7%, p<0.001) postoperative day between the two groups. Conclusion: Intravenous and topical intra-articular TXA can reduce the transfusion requirement and blood loss in rTSA.