Abstract
Background
Reverse total shoulder arthroplasty (RTSA) is an effective treatment option for multiple shoulder conditions. It is unclear if seasonal timing of surgery affects outcomes.
Methods
Patients who underwent RTSA between 2015–2021 and were enrolled in a multicenter registry were eligible for inclusion. Date of surgery was divided into winter, spring, summer and fall. Patient reported outcomes, range of motion and complications at 2 years’ follow up were assessed and compared between RTSA groups for each season.
Results
863 patients were included. Breakdown by season was: winter (N = 214); spring (N = 183); summer (N = 178); fall (N = 288). There were no differences in 2-year clinical outcomes, range of motion, complications or strength between groups with the exception that patients who underwent RTSA in the fall had a higher Constant-Murley score and better active internal rotation at 90 degrees than in other seasons (p = 0.036 and p = 0.013, respectively).
Conclusion
There were very few differences in clinical outcomes based on seasonal timing for patients who undergo RTSA. Patients should feel confident that their outcomes will not vary based on the season in which they undergo RTSA.
Keywords: Reverse total shoulder arthroplasty, clinical outcome, season, month, shoulder, surgery
Introduction
Reverse total shoulder arthroplasty (RTSA) has become a reliable, reproducible and successful procedure for multiple shoulder pathologies.1–4 While RTSA can be utilized in the trauma setting to effectively treat acute proximal humerus fractures, the majority of RTSA are performed in the elective setting for glenohumeral arthritis with a nonfunctional rotator cuff.5,6 Hence, patients can often choose when during the year they undergo their surgery, and thereby decide during what portion of the year they will do their rehabilitation. However, it is unclear if the final outcome following RTSA is affected by the time of year when the surgery is performed.
As RTSA is used to treat a wide variety of patients, the time of the year patients choose to have surgery can vary greatly based on personal factors. Some patients who live in the north do not want to miss golf season, so they elect to have their surgery in the fall so that they will be ready for golf in the spring. Others are worried about using a sling during the time of year when it may snow and therefore opt for surgery in the spring or summer. No study to date has evaluated the effect of seasonal timing on the clinical outcomes following RTSA.
Therefore, the purpose of this study was to compare clinical outcomes and complication rates based on the season of surgery in patients following RTSA. The authors hypothesized that there would be no difference in clinical outcomes or complications between patients based on the season (winter, spring, summer, fall) in which the patients underwent RTSA.
Methods
A retrospective review was performed of patients who underwent RTSA with either a short or standard length stemmed humeral component (Univers™ II, Univers™ Apex, Univers Revers® Modular Glenoid System (Arthrex, Inc., Naples, FL). Between 2015–2021 and were enrolled in prospective multicenter registry (Shoulder Arthroplasty Research Committee (ShARC) registry). Inclusion criteria were primary reverse total shoulder arthroplasty for rotator cuff tear arthropathy or glenohumeral osteoarthritis and a minimum of 2-year follow-up. Surgical technique was performed based on surgeon preference. Exclusion criteria were: inflammatory arthritis, acute and chronic fractures, arthroplasty for tumors, revision arthroplasty and incomplete follow-up. Institutional review board approval was obtained prior to initiating the prospective registry and all patients consented to participation at the time of enrollment. Patients were divided into four groups based on their surgical date: those who underwent surgery in the winter (21st December–19th March), spring (20th March–20th June), summer (21st June–22nd Sept) and fall (23rd Sept–20th Dec).
Clinical evaluation
Preoperative and postoperative clinical outcome scores were recorded in all patients. These scores included the American Shoulder and Elbow Surgeons (ASES), Visual Analog Scale (VAS), Western Ontario Arthritis of the Shoulder Index (WOOS) and Single Assessment Numeric Evaluation (SANE). Range of motion (ROM) was also recorded at baseline and at 2 year follow up for forward flexion (FF), internal rotation (IR) and external rotation (ER). Complications including fracture, loosening, instability, infection and medical complications were recorded.
Statistics
All statistical analyses were performed in SPSS, Version 29 (IBM Corporation, Armonk, NY, USA). Shapiro-Wilk tests were used to assess if continuous variables were normally distributed. As multiple comparisons were used, a one-way ANOVA was used to compare the four groups for normally distributed data, and Kruskal-Wallis tests were used when data was not normally distributed. For all statistical comparisons, p < 0.05 was considered statistically significant.
Results
There were 863 patients included in the analysis. Of these, 214 patients underwent RTSA in the winter, 183 patients underwent RTSA in the spring, 178 patients underwent RTSA in the summer and 288 patients underwent RTSA in the fall. There were no differences in baseline demographics between groups with the exception patients in the spring were younger and had a higher BMI compared to patients in other seasons (Table 1). Similarly, there were no differences in baseline range of motion (ROM), clinical outcome scores or strength between seasonal groups with the exception that patients who underwent RTSA in the winter had a higher baseline belly press strength (Table 2).
Table 1.
Demographic comparison of RTSA stratified by season.
| Patient Characteristics | Winter (N = 214) | Spring (N = 183) | Summer (N = 178) | Fall (N = 288) | p | ||||
|---|---|---|---|---|---|---|---|---|---|
| Demographics | |||||||||
| Age: years (mean, s.d.) | 70.3 | 7.3 | 68.5 | 8.1 | 70.8 | 7.5 | 69.1 | 8.3 | 0.014 |
| Sex: male (n, %) | 111 | 51.9% | 93 | 50.8% | 81 | 45.5% | 155 | 53.8% | >0.05 |
| BMI: kg/m2 (mean, s.d.) | 29.9 | 5.7 | 31.1 | 6.5 | 29.0 | 5.8 | 30.8 | 6.3 | 0.003 |
| Dominant arm: yes (n, %) | 125 | 58.4% | 101 | 55.2% | 114 | 64.0% | 177 | 61.5% | >0.05 |
| Tobacco use: yes (n, %) | 14 | 6.5% | 8 | 4.4% | 8 | 4.5% | 17 | 5.9% | >0.05 |
| Diabetes Mellitus: yes (n, %) | 25 | 11.7% | 25 | 13.7% | 19 | 10.7% | 37 | 12.8% | >0.05 |
| Glenosphere Diameter | |||||||||
| 33 (n, %) | 26 | 12.1% | 21 | 11.5% | 24 | 13.5% | 41 | 14.2% | >0.05 |
| 36 (n, %) | 87 | 40.7% | 77 | 42.1% | 78 | 43.8% | 102 | 35.4% | >0.05 |
| 39 (n, %) | 71 | 33.2% | 56 | 30.6% | 48 | 27.0% | 93 | 32.3% | >0.05 |
| 42 (n, %) | 30 | 14.0% | 29 | 15.8% | 28 | 15.7% | 52 | 18.1% | >0.05 |
| Glenoid Metallic Lateralization | |||||||||
| 0–2 mm (n, %) | 18 | 8.4% | 12 | 6.6% | 17 | 9.6% | 22 | 7.6% | >0.05 |
| 4 mm (n, %) | 72 | 33.6% | 67 | 36.6% | 69 | 38.8% | 108 | 37.5% | >0.05 |
| 6 mm (n, %) | 73 | 34.1% | 52 | 28.4% | 54 | 30.3% | 88 | 30.6% | >0.05 |
| 8 mm (n, %) | 51 | 23.8% | 52 | 28.4% | 38 | 21.3% | 70 | 24.3% | >0.05 |
Table 2.
Baseline comparison of RTSA stratified by season.
| Variable | Winter (N = 214) | Spring (N = 183) | Summer (N = 178) | Fall (N = 288) | p | ||||
|---|---|---|---|---|---|---|---|---|---|
| Mean | Std. Dev. | Mean | Std. Dev. | Mean | Std. Dev. | Mean | Std. Dev. | ||
| Baseline PROs | |||||||||
| VAS Pain | 5.5 | 2.4 | 5.7 | 2.5 | 5.7 | 2.4 | 5.5 | 2.6 | 0.658 |
| ASES | 41.3 | 17.4 | 39.8 | 18.0 | 38.7 | 17.5 | 41.5 | 18.7 | 0.347 |
| SANE | 32.8 | 23.9 | 34.9 | 23.8 | 33.9 | 22.7 | 32.0 | 22.4 | 0.593 |
| WOOS | 39.8 | 18.3 | 35.8 | 17.9 | 36.2 | 17.3 | 38.9 | 19.6 | 0.076 |
| Constant-Murley | 39.1 | 16.3 | 36.7 | 14.4 | 37.1 | 14.2 | 36.7 | 16.1 | 0.325 |
| VR-12 Mental | 50.1 | 10.6 | 48.3 | 12.1 | 49.5 | 13.2 | 50.5 | 11.8 | 0.241 |
| Baseline ROM | |||||||||
| Active FF (degrees) | 99 | 38 | 95 | 36 | 93 | 39 | 96 | 40 | 0.588 |
| Active ER at Side (degrees) | 32 | 21 | 29 | 21 | 29 | 19 | 27 | 20 | 0.067 |
| Active ER at 90 (degrees) | 26 | 28 | 24 | 28 | 22 | 28 | 25 | 29 | 0.598 |
| Active IR (spinal level) | 16.0 | 3 | 17 | 3 | 17 | 3 | 17 | 3 | 0.071 |
| Active IR at 90 (degrees) | 10 | 25 | 22 | 26 | 16 | 22 | 20 | 24 | 0.144 |
| Baseline Strength | |||||||||
| Constant-Murley | 4.8 | 6.2 | 4.6 | 5.5 | 4.1 | 4.2 | 4.4 | 5.1 | 0.546 |
| ER in neutral | 5.4 | 4.9 | 6.1 | 4.7 | 5.8 | 4.0 | 6.1 | 4.8 | 0.709 |
| Belly Press | 9.0 | 6.2 | 8.2 | 5.9 | 7.4 | 4.5 | 7.4 | 4.9 | 0.006 |
When evaluating 2-year outcomes, there were no differences in any of the patient reported outcome scores, strength or ROM between seasonal groups with the exception that patients who underwent RTSA in the fall had a higher Constant-Murley score (77.5 vs. 74.8 (winter), 73.5 (spring), 72 (summer)) and better active internal rotation at 90 degrees of abduction (37 vs. 31 (winter), 34 (spring), 29 (summer) compared to patients who underwent RTSA in other seasons (p = 0.036 and p = 0.013 respectively (Table 3). Finally, when comparing complication rates between groups there were no statistically significant differences in any of the measured complications between seasons (Table 4).
Table 3.
Comparison of 2 year postoperative outcomes for RTSA stratified by season.
| Variable | Winter (N = 214) | Spring (N = 183) | Summer (N = 178) | Fall (N = 288) | p | ||||
|---|---|---|---|---|---|---|---|---|---|
| Mean | Std. Dev. | Mean | Std. Dev. | Mean | Std. Dev. | Mean | Std. Dev. | ||
| 2 Year PROs | |||||||||
| VAS Pain | 1.1 | 2.0 | 1.1 | 1.9 | 1.0 | 1.9 | 0.9 | 1.9 | 0.651 |
| ASES | 82.9 | 17.7 | 82.6 | 16.9 | 82.8 | 16.8 | 85.5 | 15.8 | 0.152 |
| SANE | 75.0 | 25.6 | 75.0 | 26.1 | 73.5 | 26.6 | 76.9 | 24.9 | 0.565 |
| WOOS | 85.4 | 18.1 | 84.7 | 18.8 | 85.0 | 18.2 | 88.0 | 16.7 | 0.138 |
| Constant-Murley | 74.8 | 17.6 | 73.5 | 18.5 | 72.0 | 18.2 | 77.5 | 15.2 | 0.036 |
| VR-12 Mental | 53.1 | 9.5 | 54.3 | 8.9 | 53.7 | 9.3 | 54.2 | 8.6 | 0.480 |
| 2 Year ROM | |||||||||
| Active FF (degrees) | 141 | 24 | 139 | 27 | 139 | 24 | 140 | 24 | 0.911 |
| Active ER at Side (degrees) | 45 | 17 | 50 | 21 | 46 | 20 | 48 | 18 | 0.125 |
| Active ER at 90 (degrees) | 60 | 28 | 62 | 25 | 55 | 28 | 62 | 27 | 0.094 |
| Active IR (spinal level) | 15 | 4 | 16 | 3 | 16 | 3 | 16 | 3 | 0.145 |
| Active IR at 90 (degrees) | 31 | 23 | 34 | 20 | 29 | 23 | 37 | 21 | 0.013 |
| 2 Year Strength | |||||||||
| Constant-Murley | 9.0 | 5.3 | 9.8 | 8.1 | 8.7 | 4.7 | 10.0 | 5.6 | 0.367 |
| ER in neutral | 9.3 | 4.9 | 9.9 | 5.9 | 9.4 | 4.5 | 10.3 | 5.5 | 0.322 |
| Belly Press | 9.6 | 4.1 | 9.7 | 4.9 | 9.2 | 4.8 | 10.3 | 4.7 | 0.256 |
Table 4.
Comparison of adverse events of RTSA stratified by season.
| Variable | Winter (N = 214) | Spring (N = 183) | Summer (N = 178) | Fall (N = 288) | p | ||||
|---|---|---|---|---|---|---|---|---|---|
| Adverse Events | |||||||||
| Overall (n, %) | 20 | 9.3% | 16 | 8.7% | 18 | 10.1% | 25 | 8.7% | >0.05 |
| Postoperative Fracture (n, %) | 5 | 2.3% | 4 | 2.2% | 2 | 1.1% | 5 | 1.7% | >0.05 |
| Loosening (n, %) | 2 | 0.9% | 2 | 1.1% | 4 | 2.2% | 3 | 1.0% | >0.05 |
| Instability (n, %) | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | 1 | 0.3% | >0.05 |
| Infection (n, %) | 1 | 0.5% | 1 | 0.5% | 0 | 0.0% | 0 | 0.0% | >0.05 |
| Other Medical (n, %) | 15 | 7.0% | 9 | 4.9% | 13 | 7.3% | 16 | 5.6% | >0.05 |
Discussion
RTSA is an effective treatment option for multiple shoulder pathologies. The author's hypotheses were mostly confirmed as there were very few differences in clinical outcomes scores and ROM between patients who underwent RTSA in different seasons. Patients who underwent RTSA in the fall had significantly greater internal rotation strength and higher Constant-Murley scores. While these differences were statistically significant they are unlikely to be clinically significant.
Postoperative outcomes following RTSA for a variety of indications have been well described.7–10 Erickson et al. reported the results of 577 patients who underwent a RTSA with either a short stem (n = 220) or standard-length stem (n = 357). 7 At short term follow up the authors found significant improvements in clinical outcome scores and range of motion in both groups, although the short stem group had more significant increases in ROM. Mizuno et al. reported outcomes of 27 patients who underwent RTSA for glenohumeral arthritis with a biconcave glenoid and rotator cuff deficiency. 11 At an average follow up of 54 months the authors saw significant improvements in patient reported outcome scores as well as ROM in all planes of motion. While these studies and countless others have demonstrated excellent outcomes following RTSA, no study to date has compared outcomes following RTSA based on the seasonal timing of surgery.
While patients often think about seasonal timing as it relates to the weather or what activities they can do, there is also a surgical training component that comes into play based on the time of the year. New orthopaedic residents and fellows start in July and August respectively. Rao et al. used a large database to evaluate patients who underwent TSA in the first academic quarter compared to the rest of the year to determine if a higher complication rate existed in July, August and September, when new trainees begin. 12 The authors included 711 TSA where a resident or fellow was involved with the case, of which 390 were performed in the first academic quarter. The authors found no difference in complication rates or adverse events between patients who underwent TSA in the first academic quarter compared to the rest of the year. However, the authors did not evaluate clinical outcomes. Patients included in the current study were treated in both academic and non-academic centers, but the results of this study do not demonstrate any issues with RTSA surgery that was performed in the summer months.
While RTSA has become a much more common procedure in the United States, the number of RTSA performed each year pales in comparison to the number of total hip arthroplasty (THA) procedures. Lachance et al. performed a similar study to the present study and evaluated 6418 patients who underwent primary THA over a seven-year time span. 13 The authors had a relatively even breakdown of patients in each seasonal group. They found no differences in patient reported outcome scores or complication rates between seasonal groups and concluded that patients should feel confident having their elective THA at any point during the year. These results mirror the results of this study where almost all outcome scores were similar across seasons with the exception of a slightly better Constant-Murley score and slightly better active internal rotation at 90 degrees of abduction when surgery was performed in the fall.
Patients should feel comfortable undergoing RTSA at any point in the year as it does not appear the season in which they have their surgery impacts their outcomes. This is an important finding to allow surgeons to properly counsel their patients regarding the outcomes following surgery, and should allow surgeons to feel confident recommending RTSA at any point in the year.
Limitations
There are several limitations to the present study. The surgeons who enroll patients in the multi-center registry included in this study are fellowship trained sports and shoulder and elbow surgeons with a high level of experience in shoulder arthroplasty surgery. These results may not be generalizable to all surgeons and patient populations. Additionally, 2-year outcomes are relatively short-term, and differences could be found at later follow-up. Surgical technique was not standardized across the various sites so subscapularis management may have differed. Finally, data on trainee participation in each surgery was not available so this could not be analyzed.
Conclusion
There were very few differences in clinical outcomes based on seasonal timing for patients who undergo RTSA. Patients who underwent RTSA in the fall had a better Constant-Murley Score and active internal rotation at 90 degrees of abduction. Patients should feel confident that their outcomes will not vary based on the season in which they undergo RTSA.
Shoulder Arthroplasty Research Committee (ShARC) authorship:
| Anup Shah | anupshah78@gmail.com |
| Asheesh Bedi | asheesh.bedi@gmail.com |
| Bradford Parsons | bradford.parsons@mountsinai.org |
| Bruce Miller | bsmiller@umich.edu |
| Christopher O'Grady | ogradymd@yahoo.com |
| Daniel Davis | daniel.davis@rothmanortho.com |
| David Lutton | dmlutton@gmail.com |
| Joern Steinbeck | j.steinbeck@oppk.de |
| John Tokish | tokish.john@mayo.edu |
| Julia Lee | lee.julia@gmail.com |
| Kevin Farmer | farmekw@ortho.ufl.edu |
| Matthew Provencher | mmpro@mac.com |
| Michael Bercik | michael.bercik@gmail.com |
| Michael Kissenberth | michael.kissenberth@prismahealth.org |
| Patric Raiss | patric.raiss@gmail.com |
| Peter Habermeyer | peter.habermeyer@atos.de |
| Philipp Moroder | philipp.moroder@icloud.com |
| Russell Huffman | grussellhuffman@outlook.com |
| Samuel Harmsen | gwsharmsen@gmail.com |
| Tyrrell Burrus | tyrrellburrus@gmail.com |
| Tyler Brolin | tbrolin@campbellclinic.com |
| Anthony Romeo | anthony.romeo@duly.com |
| R. Alexander Creighton | alex_creighton@med.unc.edu |
| Justin W. Griffin | justinwilliamgriffin@gmail.com |
| Albert Lin | lina2@upmc.edu |
| Dirk Petre | bvba.dr.dirk.petre@skynet.be |
Acknowledgements
None
Footnotes
Contributorship: All authors contributed to patient enrollement as well as manuscript conception and editing.
ORCID iDs: Brandon J Erickson https://orcid.org/0000-0003-3238-7839
Patrick J Denard https://orcid.org/0000-0002-2641-5920
Brian C Werner https://orcid.org/0000-0002-7956-2123
Declaration of conflicting interests: Brandon J. Erickson – AAOS: Board or committee member American Orthopaedic Society for Sports Medicine: Board or committee member American Shoulder and Elbow Surgeons: Board or committee member Arthrex, Inc: Paid consultant; Research support DePuy, A Johnson & Johnson Company: Research support Linvatec: Research support PLOS One: Editorial or governing board Smith & Nephew: Research support Stryker: Research support
Patrick Denard - Arthrex, Inc: IP royalties; Paid consultant; Paid presenter or speaker; Research support Orthopedics Today: Editorial or governing board Pacira: Paid presenter or speaker Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support
Evan Lederman - American Shoulder and Elbow Surgeons: Board or committee member Arthrex, Inc: IP royalties; Paid consultant; Paid presenter or speaker; Research support PTGenie: Stock or stock Options Smart Medical Devices Inc: Stock or stock Options
Reuben Gobezie - Arthrex, Inc: IP royalties; Paid consultant; Paid presenter or speaker; Research support Research Committee- American Shoulder & Elbow SocietyClosed and Open Program Committee–American Shoulder & Elbow SocietyTechnology Committee–American Shoulder & Elbow SocietyResearch Committee–OREFResearch Committee–AANAShoulder and Elbow Program Committee–AAOS: Board or committee member
Ben Sears - Aevumed, Inc.: IP royalties Arthrex, Inc: Research support BioPoly: IP royalties Exactech, Inc: Research support FX Solutions: Research support Tornier: Research support United Orthopedic Corporation: IP royalties; Paid consultant
Dr Anup Shah reports the following conflicts of interest:
• Arthrex, Inc.: Education/research consultant
• Medacta: Royalties
Dr Asheesh Bedi reports the following conflicts of interest:
• Arthrex, Inc.: Consultant and royalties
Dr Bradford Parsons reports the following conflicts of interest:
• Arthrex, Inc.: Consultant and royalties
• Editor JBJS reviews
Dr Bruce Miller reports the following conflicts of interest:
• AJSM: Editorial or governing board
• Arthrex, Inc.: Paid consultant
• FH Orthopedics: Royalties
Dr Christopher O’Grady reports the following conflicts of interest:
• Education consultant/Speaker for: Arthrex, Inc., Stryker, Smith and Nephew, Mitek
Dr Daniel Davis reports the following conflicts of interest:
• Arthrex, Inc.: Paid consultant, paid presenter/speaker
• Catalyst OrthoScience: Stock or stock options
• Board Member: Pennsylvania Orthopaedic Society
• Board Member: Philadelphia Orthopaedic Society
Dr David Lutton reports the following conflicts of interest:
• Arthrex, Inc.: Paid consultant, Paid speaker or presenter
• Avanos: Paid speaker or presenter
• CORE: Reviewer (not Editor)
Dr Jorn Steinbeck reports the following conflicts of interest:
• Reviewer: JSES, JBJS
• Arthrex, Inc.: Consultant
Dr John Tokish reports the following conflicts of interest:
• Arthrex, Inc: IP royalties; Paid consultant; Paid presenter or speaker
• Arthroscopy Association of North America: Board or committee member
• Journal of Shoulder and Elbow Surgery: Editorial or governing board, financial or material support
• Orthopedics Today: Editorial or governing board
Dr Julia Lee reports the following conflicts of interest:
• Arthrex, Inc.: Consulting and medical education
• American Shoulder Elbow Society – Committee member
Dr Kevin Farmer reports the following conflicts of interest:
• American Orthopaedic Society for Sports Medicine Florida Orthopaedic Society: Board or committee member
• Arthrex, Inc. Paid consultant, paid presenter or speaker
• Exactech, Inc.: Paid consultant
Dr Mathew Provencher reports the following conflicts of interest:
• Royalties from Arthrex, Inc. Arthrosurface, Responsive Arthroscopy (2020), and Anika Therapeutics, Inc.;
• Consulting fees from Arthrex, Inc., Joint Restoration Foundation (JRF), Zimmer Biomet Holdings, and Arthrosurface
• received grants from the Department of Defense (DoD), the National Institute of Health (NIH), and the DJO (2020)
• Honoria from Flexion Therapeutics
• Editorial board or governing board member for SLACK, Inc.
• Board or committee member for AANA, AAOS, AOSSM, ASES, SDSI, and SOMOs
• serves on the medical board of trustees for the Musculoskeletal Transplant Foundation (through 2018)
Dr Michael Bercik reports the following conflicts of interest:
• American Shoulder and Elbow Surgeons: Board or committee member
• Arthrex, Inc: Paid consultant
• WRS Specialists: Paid consultant
Dr Michael Kissenberth reports the following conflicts of interest:
• Paid consultant for a company or supplier: Arthrex, Inc.
• Financial or material support from a company or supplier: Hawkins Foundation
• Board Member: Hawkins Foundation
Dr Patric Raiss reports the following conflicts of interest:
• Paid consultant for Arthrex, Inc.
• Shareholder Zurimed Technologies AG
Dr Peter Habermeyer reports the following conflicts of interest:
• Royalties Arthrex, Inc.
Dr Philipp Moroder reports the following conflicts of interest:
• Consultant for Alyve Medical, Arthrex, and Medacta
• Receives royalties from Alyve Medical, Arthrex, and Medacta
Dr G. Russell Huffman reports the following conflicts of interest:
• Speakers bureau/paid presentations for a company or supplier: Arthrex, Inc., LIMA
• Paid consultant for a company or supplier: Arthrex, Inc., LIMA
• Stock or stock options in a company or supplier: Catalyst
• Research support from a company or supplier as a PI: LIMA IDE
Dr Samuel Harmsen reports the following conflicts of interest:
• Arthrex, Inc: Royalties; Paid consultant; Paid presenter or speaker; Research support
• Embody, Inc: Royalties; Paid consultant
• Enovis, Inc: Paid consultant; paid presenter
• Genesis Software Innovations, LLC: Royalties; Stock or stock options
• Shoulder Innovations, Inc: Royalties, Paid consultant; Paid presenter or speaker
• Zimmer US Inc; Paid consultant; Paid presenter or speaker; Stock or stock options
Dr Matthew Tyrrell Burrus reports the following conflicts of interest:
• Arthrex, Inc: Paid consultant; Paid presenter or speaker; Research support
• Arthroscopy: Editorial or governing board
Dr Tyler Brolin reports the following conflicts of interest:
• AAOS: Board or committee member
• American Shoulder and Elbow Surgeons: Board or committee member
• Arthrex, Inc: IP royalties; Paid consultant; Research support
• Elsevier: Publishing royalties, financial or material support
• Orthofix, Inc.: Research support
• Orthopedic Clinics of North America: Editorial or governing board
• Zimmer: Research support
Dr Anthony Romeo reports that from Arthrex Inc. he receives royalties, research support and is a paid consultant; from Saunders/Mosby-Elsevier and SLAC Inc he receives publishing royalties and financial or material support; from AANA and MLB he receives other financial or material support; from Paragen Technologies research support and stock or stock options.
Dr Alexander Creighton is a consultant for Arthrex and receives research support from Arthrex, Breg and Smith & Nephew
Dr Justin Griffin reports that from Arthrex inc. he receives research support, royalties and is a paid consultant and that from Springer her receives publishing royalties.
Dr Albert Lin reports that he is a paid consultant for Arthrex and Tornier. He is a Board or committee member of AAOS, AOA, AOSSM, ASES and ISAKOS.
Dr Dirk Petre reports the following conflicts of interest:
• Arthrex, Inc.: Paid consultant, paid presenter/speaker, research support
Brian Werner - AAOS: Board or committee member American Orthopaedic Society for Sports Medicine: Board or committee member American Shoulder and Elbow Surgeons: Board or committee member Arthrex, Inc: Paid consultant; Paid presenter or speaker; Research support Biomet: Research support Exactech, Inc: Research support Flexion Therapeutics: Research support
Ethical approval: Souther Oregon IRB
Funding: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Arthrex, (grant number Arthrex, Inc. grant # AIRR-00608-94).
Guarantor: BJE
Informed Consent: Obtained when patients were enroilled in the registry
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