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Background Controversy exists in reverse total shoulder arthroplasty in regard to variability in the center of rotation (COR), which modifies the superior-inferior position of the humerus to affect the acromiohumeral interval (AHI), and its effect on the deltoid lever arm (DLA), acromial index (AI), and critical shoulder angle (CSA). The purpose of this study was to investigate the variation in biomechanics and the association with patient-reported outcomes (PROs) and range of motion (ROM) measurements. Methods Radiographs, ROM, and 2-year PRO scores were retrospectively reviewed for 108 patients. Results There was large variability in preoperative and postoperative biomechanics. The COR was medialized 12.01 ± 4.8 mm. The CSA increased 2.64° ± 12.45°. The AHI increased 20.6 ± 9.80 mm. The DLA lengthened 21.21 ± 10.15 mm. The AI increased 0.009 ± 0.3. Postoperative AI positively correlated with American Shoulder and Elbow Surgeons score and Penn Shoulder Score ( P = .03). Specifically, a postoperative AI of 0.62 corresponded to American Shoulder and Elbow Surgeons score (72.5 ± 18.3 vs. 62.3 ± 24.7; P = .02) and Penn Shoulder Score (71.2 ± 21.4 vs. 61.8 ± 25.6; P = .05), an average 10 points higher than AI of <0.6. Also, a smaller postoperative CSA (<25°) correlated with improved forward elevation ( P = .02). Conclusions This is the first study that evaluates the variability of biomechanical factors and their impact on postoperative ROM and PROs. An increased AI and decreased CSA are associated with improved PROs in this study, and a smaller CSA is associated with better forward elevation. Change in the COR, AHI, or DLA, however, did not affect patient outcomes or ROM. Further study is warranted to determine the optimal position.

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Background: There has been a surge in interest with regard to the utility of liposomal bupivacaine as part of a perioperative pain management protocol. The current study was proposed to critically assess the efficacy of liposomal bupivacaine as a local anesthetic for pain relief following orthopaedic procedures. Methods: A systematic review of prospective, randomized trials involving liposomal bupivacaine was performed using searches of the PubMed, Embase, and Cochrane databases. The primary outcomes of interest included postoperative subjective pain scores and narcotic consumption. The length of stay and postoperative mobility were reviewed as secondary outcomes. Results: Twenty-seven studies met inclusion criteria and were included for review. Twelve of 17 studies concluded that periarticular or local infiltrative liposomal bupivacaine offered no additive benefit compared with other local anesthetic injections. Peripheral nerve blocks without liposomal bupivacaine conferred more optimal pain relief and decreased narcotic consumption in the immediate postoperative period when compared with liposomal bupivacaine, with no differences thereafter. Twelve studies listed a conflict of interest related to the drug manufacturer (Pacira Pharmaceuticals). Eight of these studies (67%) demonstrated clinical superiority of liposomal bupivacaine when compared with the study control. In the 15 studies that did not show a conflict of interest, only 1 study (7%) demonstrated therapeutic superiority with use of periarticular liposomal bupivacaine when compared with a historical cohort that received no local or regional anesthesia. Conclusions: Current prospective, randomized controlled trials in patients undergoing orthopaedic surgery fail to support the routine use of liposomal bupivacaine compared with other local injectable analgesics, particularly in the setting of knee replacement surgery. We were unable to find consistent support for the potential of superior pain relief and narcotic use reduction with the use of liposomal bupivacaine. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

A comparison of proprietary allograft processing techniques is difficult because of the variability and lack of specificity of reporting in the current literature. Among the available literature, except for the Tutoplast process, no notable differences were found in the clinical outcomes or biomechanical properties. Future study with a longer follow-up is necessary to determine the role and limitations of these grafts in the clinical setting.

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