Demographics & Risk

Impact of race, ethnicity, and socioeconomic status on shoulder pathology epidemiology, surgical access, and clinical outcomes.

Overview

Age at index arthroplasty significantly affects outcomes and the risk of revision [1]. Surgeons and patients must consider the impact of age on patient course and outcomes regardless of the presence of comorbidities [2]. Advanced age should not be used as the sole determinant of perioperative survival [5]. Postoperative survival justifies the resources utilized in revision surgery regardless of age [5]. Complication rates for proximal hamstring avulsion surgery were similar between patients under and over 50 years [9]. Patients under and over 50 years experienced greater gains in outcomes for proximal hamstring avulsion surgery, with greater gains observed in the younger group [9].

A specific BMI threshold cannot be recommended as a screening tool for postoperative complications [4]. BMI should be incorporated as a component of the comprehensive preoperative clinical assessment [4]. The use of eligibility criteria for primary TSA or RSA based solely on BMI threshold values presents a potential limitation in access to care [11]. Patients who would otherwise have a complication-free procedure may be limited in access to care if BMI thresholds are used as eligibility criteria [11]. The institution of BMI eligibility cutoffs for knee arthroscopy would result in low positive predictive values [40]. The institution of BMI eligibility cutoffs for knee arthroscopy would result in a high number of denials for surgery that would otherwise be complication-free [40]. Underweight body mass index is associated with increased in-hospital complications after revision total joint arthroplasty [42]. Underweight body mass index is associated with increased length of stay after revision total joint arthroplasty [42]. Standardized preoperative protocols should be developed and instituted to improve outcomes in underweight patients undergoing revision total joint arthroplasty [42].

Age, race, insurance status, surgical indication, and number of spinal levels included in the arthrodesis were associated with reoperation risk after cervical spine arthrodesis [36]. THA candidates with a high comorbidity burden may benefit from referral to high-volume surgeons to reduce procedural risk [43]. THA candidates with a high comorbidity burden may benefit from referral to high-volume surgeons to improve postoperative outcomes [43]. There is no appreciable effect of gender on implant survivorship in hip resurfacing arthroplasty [44]. Women can be excellent candidates for hip resurfacing arthroplasty if optimized surgical technique is used to offset risks associated with small component size [44].

Anatomy & Pathophysiology

Kinematics and Kinetics

Temporal and kinematic motions at the shoulder are prominent predictors of shoulder anterior force in high school and professional baseball pitchers [32]. Disruption of the kinetic chain mechanism predisposes athletes to shoulder injury [33]. Multiple upper extremity and trunk kinematic parameters affect ball velocity, with significant contributions from the throwing shoulder, trunk, and nondominant arm [39]. In 9- to 10-year-old baseball athletes, shoulder maximum internal rotation velocity and shoulder kinetics increase during a simulated game [52]. Athletes completing 105 pitches in windmill softball are able to maintain shoulder kinematics and ball speed during the underhand pitch [53].

Sagittal plane trunk tilt affects both pitching performance and elbow moments in collegiate baseball pitchers [78]. Arm slot position is related to shoulder abduction and trunk lateral tilt in high school and professional pitchers [82]. No relationship was found between stride position, stride-foot progression angle, and shoulder distraction force in collegiate softball pitchers [64]. In young female baseball players, pitching kinematics and kinetics causing increases in elbow joint load depend on shoulder kinematics [65]. Overhead athletes with shoulder injury history demonstrate similar kinetic chain sequencing across lower limb and lumbopelvic-hip complex segments as those without injury history, with differences only in the timing of peak elbow extension and shoulder flexion angular velocities [81].

Optimum restoration of shoulder function requires activation of all kinetic chain segments to re-establish pre-injury interactions [55]. Players can throw at close to half effort to reduce elbow kinetics while maintaining kinematics occurring at 100% effort pitching [57]. Increased pitch velocity and workload are common risk factors for ulnar collateral ligament injury in baseball players [79].

Osseous and Structural Morphology

The critical shoulder angle is unaffected by demographic factors [54]. Shoulder internal/external rotation in abduction and adduction is not interchangeable in children with brachial plexus birth injury [83].

Neural and Muscular Function

Shoulder muscle imbalance alone causes neither subscapularis shortening nor internal rotation contracture following neonatal brachial plexus injury [68]. Serratus anterior reconstruction is recommended to achieve optimal shoulder function via nerve transfers [71]. Transfer of the branch to the long head triceps brachii of the radial nerve to the anterior branch of the axillary nerve can provide shoulder abduction and shoulder extension functions of the posterior deltoid [74].

Classification

Age: Age at index arthroplasty affects outcomes and the risk of revision [1]. Demographic variables such as advanced age significantly affect scores on knee symptom evaluation systems [85]. The risk of Osgood-Schlatter disease increases with age in males but not in females [31].

ASA Class: Patients identified as being at higher risk (ASA class 3 or 4) preoperatively should be closely managed medically so that perioperative medical complications can be managed and evolving medical issues can be addressed in a timely fashion [20].

Diagnostic Cluster: Complication patterns vary by diagnostic cluster, with the highest revision risk observed in patients with schizophrenia spectrum disorders (F20 to F29) and extrapyramidal/parkinsonian disorders (G20 to G26) [15].

BMI: Controlling for comorbidities and known risk factors for instability, there is no difference in rates of dislocation or revision for instability between normal-weight patients and those in higher BMI classes [28].

Kellgren-Lawrence: Categorizing Kellgren-Lawrence stages into early (KL≤2) and advanced (KL≥3) groups improved interobserver reliability [91].

FEDS: There are 16 categories within the FEDS classification that are clinically significant [38].

5P Risk Score: The odds of developing persistent postconcussive symptoms increases with each point increase on the 5P risk score [93].

Other Considerations: Demographic variables such as low family income and multiple medical conditions significantly affect scores on knee symptom evaluation systems [85].

Clinical Presentation

Age significantly impacts patient course and outcomes in elective total hip arthroplasty, independent of comorbidities [2]. For hip fracture surgery, patients identified as higher risk (ASA class 3 or 4) preoperatively require close medical management to address perioperative complications and evolving medical issues [20]. In shoulder instability surgery, the risk of 30-day readmission and overnight hospital stay increases with patient age [50].

Dependent functional status is a risk factor for perioperative and postoperative complications after total hip arthroplasty [19]. Additional investigations are indicated to identify at-risk patients for total knee arthroplasty based on social predictors such as marital status, race, insurance type, and socioeconomic status [12]. For closed patella fracture patients, individualized risk stratification and early anticoagulation are recommended if risk factors include age ≥ 65 years, D-dimer > 0.5 mg/L, and albumin < 35g/L [13]. Identified risk factors for preoperative deep venous thrombosis after femoral neck fracture in the elderly aid in patient counseling, individualized risk assessment, and risk stratification [37].

Complication patterns in knee arthroplasty for patients with psychiatric and neurologic comorbidities vary by diagnostic cluster. Highest revision risk is observed in patients with schizophrenia spectrum disorders (F20 to F29) and extrapyramidal/parkinsonian disorders (G20 to F26) [15]. Independent predictors of early revision total hip arthroplasty include obesity and a diagnosis of anxiety/depression [47].

Greater diagnosis severity at presentation in neuromuscular scoliosis may affect surgical outcomes and pose a higher risk of postoperative complications [6]. The accuracy of inflammatory biomarkers in diagnosing periprosthetic joint infection varies significantly among demographic groups [14]. Consensus on diagnostic criteria for thoracic outlet syndrome has not been established [7]. Modern comprehensive diagnostic criteria for rapidly progressive osteoarthritis of the hip have been proposed for the Southeast Asian population [18].

Concussions are a form of traumatic brain injury with a wide range of severity, and early detection through thorough knowledge of signs and symptoms is critical for management [46]. Individuals with at least one previous undiagnosed concussion exhibit worse baseline clinical indicators [3]. Certain variables are associated with increased symptoms across multiple concussion clusters and may indicate greater injury severity, while other factors are associated with specific symptom presentations [45].

Concussions were the most common injury diagnosis in intercollegiate water polo athletes, had the worst return-to-play outcomes among common diagnoses, and were mostly sustained outside of competition [49]. The HITS database identifies high-risk conditions and characterizes management outcomes for injuries in professional baseball [16]. Understanding injury epidemiology, including return to play rates and career duration, allows treating physicians to gain player trust, understand prognosis, and guide players back to the field safely [17].

Investigations

Plain radiography: Age at index arthroplasty affects outcomes and the risk of revision [1]. Knee pain scores increase the ability to identify participants with radiographic KL ≥ 2 in both sexes [109]. The excess of knee radiographic osteoarthritis among symptomatic males is unlikely to be attributable to the use of comprehensive X-ray views [90]. Radiographical parameters that stratify risk of recurrent patellar dislocation in adults are also able to predict recurrent patellar dislocation in the pediatric population [104]. A deltoid tuberosity index cutoff of 1.6 may help prompt clinicians to initiate workup and manage underlying osteoporosis in an Asian population [108].

MRI: The incidence of pathology identified on knee MRI scans in asymptomatic players at the NBA Draft Combine was high, with little correlation found between objective imaging findings and subjective pain, function, and orthopaedic injury history [77]. MRI-defined patellar tendinopathy is common in community-based adults and is associated with current and past history of obesity assessed by BMI or body weight, but not fat mass [94]. MRI determination of posterior interosseus nerve position is reliable and consistent with prior cadaveric study [105].

Other Considerations: Greater diagnosis severity at presentation may affect outcomes afforded by surgery and pose a higher risk of postoperative complications [6]. Additional investigations are indicated in identifying at-risk patients and subsequent optimization of these patients [12]. Understanding how the accuracy of diagnostic tests varies with respect to demographic factors can help physicians avoid subjecting patients to unnecessary additional testing and reach more accurate diagnoses of PJI [14]. Modern comprehensive diagnostic criteria for rapidly progressive osteoarthritis of the hip have been established and validated in the Southeast Asian population [18]. The prevalence of morphological variations associated with femoroacetabular impingement has been determined in the general population [29]. Validation of a novel genetic marker for risk of degenerative rotator cuff disease surgery in studies with imaging data to confirm diagnoses is an important next step [84]. There was no difference in clinical, functional, or radiological outcomes between obese and non-obese patients [96]. An evidence-based systematic approach directs patients to preoperative imaging, grading and classifying injuries using established radiological criteria, selecting patients for nonoperative treatment, and referring them appropriately for operative management [98]. Those with prior shoulder surgery had more diagnostic imaging and orthopaedic surgery in college [99]. Preoperative overweight and obesity do not cause inferior outcomes following open-wedge high tibial osteotomy, as clinical and radiological outcomes in patients with preoperative overweight, obesity, and normal-BMI were not significantly different [101]. Preoperative opioid usage predicts markedly inferior outcomes 2 years after reverse total shoulder arthroplasty, with opioid users having significantly increased rates of periprosthetic radiolucency and revision [110]. Re-revision beyond 5 years following revision knee arthroplasty in the elderly is uncommon [112].

Treatment

Non-Operative

Conservative management is the general first-line therapy for thoracic outlet syndrome [7]. For pubalgia in athletes, conservative management should be considered before surgical treatment is indicated [62]. Operative management of certain conditions yields superior results compared to non-operative care, with 84 per cent excellent-to-good results versus 59 per cent for non-operative management [97]. However, there is a significant decrease in the initial trial of nonoperative treatment and an increase in the rate of surgery for rotator cuff tears in the United States Medicare population [100].

Operative

Indications: Age at index arthroplasty affects outcomes and the risk of revision [1]. Advanced age should not be used as the sole determinant of perioperative survival [5], and postoperative survival justifies the resources utilized in revision surgery regardless of age [5]. For proximal humerus fractures, reverse total shoulder arthroplasty (rTSA) is supported as the preferred treatment strategy and consistently yields greater quality-adjusted life years and superior cost-effectiveness for patients over 65 years old [56]. Surgery for thoracic outlet syndrome is considered for patients who fail conservative therapy [7]. Factors considered refractory to conservative management of ulnar collateral ligament (UCL) injuries of the elbow in baseball players may indicate a need for UCL reconstruction surgery [89].

Patient Selection & Risk Stratification: A specific BMI threshold cannot be recommended as a screening for postoperative complications in primary total knee or total hip arthroplasty [4]. BMI should be incorporated as a component of the comprehensive preoperative clinical assessment for primary total knee or total hip arthroplasty [4] [11]. The use of eligibility criteria for primary TSA or RSA based solely on BMI threshold values presents a potential limitation in access to care [11]. Morbid obesity (BMI ≥ 35 kg/m2) is an independent risk factor for functional outcomes and implant survival after UKA [23]. High BMI should not be considered a contraindication to medial Oxford UKA when UKA is used for appropriate indications [34], and obesity alone should not preclude patients from TSA eligibility, as surgical candidacy should be evaluated in the context of patients' overall health [41]. Obesity does not appear to be a contraindication to UKA as long as other patient selection criteria are adhered to [35].

Risk factors for preoperative deep venous thrombosis in closed patella fracture include age ≥ 65 years, D-dimer > 0.5 mg/L, and albumin < 35g/L [13]. Individualized risk stratification and early anticoagulation are recommended for patients with these risk factors [13]. Optimizing preoperative kidney function through appropriate interventions might decrease the risk of poor prognosis after primary elective total hip arthroplasty in patients with diabetic kidney disease [72]. Comprehensive management strategies are crucial to mitigate adverse events given the considerable impact of peripheral artery disease on TKA outcomes [76].

Surgical Approach / Technique: Consensus in diagnostic criteria for thoracic outlet syndrome has not been established [7]. An optimized logistic regression model achieved an AUC of 0.934 for predicting patellofemoral instability risk factors in children and adolescents [69]. Radiofrequency microtenotomy for elbow epicondylitis has durable results with successful outcomes observed at nine years following surgery [73].

Implant Selection: Risk factors for overall failure after autologous chondrocyte implantation and tibial tubercle osteotomy for patellofemoral chondral defects include age less than 30 years, female sex, and tobacco use [60]. Surgical and overall failures after autologous chondrocyte implantation and tibial tubercle osteotomy for patellofemoral chondral defects were associated with periosteal patch use [60].

Other Considerations: Psychosocial factors were not associated with patient-reported outcomes after intervention for rotator cuff tears [51]. Chronic non-orthopedic conditions were significantly more prevalent in patients with less severe degenerative changes at the time of surgery [92]. Patients with chronic non-orthopedic conditions and less severe degenerative changes at the time of surgery were significantly more dissatisfied with their operation [92]. Socioeconomically disadvantaged and non-White patients who sustain ACL tears are at a greater risk of delays in the time of injury to ACLR [102]. Socioeconomically disadvantaged and non-White patients who sustain ACL tears are at a greater risk of undergoing a concomitant meniscectomy [102]. Nonagenarian patients with hip fracture differ significantly from younger patients concerning clinical characteristics, medical complications, and in-hospital and 30-day mortality rates [103]. Evaluation of fall risk factors contributes to identifying patients with bone risk factors at highest immediate risk of subsequent non-vertebral fracture despite guideline-based treatment [107].

Complications

Infection (PJI): Evidence does not provide specific incidence or risk factor data for periprosthetic joint infection within the provided bullets.

Aseptic loosening: Long-term revision rates following total hip replacement are higher among obese patients, though these rates remain acceptable by contemporary standards [67].

Instability: Younger patients (≤15 and 16 to 20 years of age) are more likely to require surgery and experience recurrent instability compared with older patients following anterior shoulder instability [113]. A history of anterior cruciate ligament reconstruction is a risk factor for further injury, with the highest risk occurring in the first year after reconstruction [25].

Periprosthetic fracture: Geriatric hip fractures are associated with high short-term morbidity and mortality [8]. Patients aged > 65 years who experienced a fragility fracture are at imminent risk of experiencing subsequent fracture within the next 2 years [111].

Thromboembolism: Evidence does not provide specific incidence or risk factor data for thromboembolism within the provided bullets.

Patellar / Extensor-mechanism: Evidence does not provide specific incidence or risk factor data for patellar or extensor-mechanism complications within the provided bullets.

Stiffness / Arthrofibrosis: Evidence does not provide specific incidence or risk factor data for stiffness or arthrofibrosis within the provided bullets.

Nerve palsy: Evidence does not provide specific incidence or risk factor data for nerve palsy within the provided bullets.

Wound complications: Evidence does not provide specific incidence or risk factor data for wound complications within the provided bullets.

Polyethylene wear: Major primary complications occur after bipolar radial head arthroplasty, with a high incidence of radiographic signs of degenerative changes after 8.8 years [114].

Other Considerations: Age impacts patient course and outcomes in elective total hip arthroplasties in nonagenarians, regardless of comorbidity presence [2]. Complication rates for proximal hamstring avulsion surgery are similar between patients under and over 50 years of age [9]. Obesity is associated with lower long-term functional outcomes and higher complication rates following total hip arthroplasty [10]. Higher Charlson comorbidity index (CCI) is associated with worse patient function and higher long-term risk of death in elderly patients with femoral neck fractures [21]. Long-term anticoagulation use is associated with poorer medical and surgical outcomes at 90 days and 2 years postoperatively in patients undergoing unicompartmental knee arthroplasty [22]. Years of experience is the only factor associated with severe injuries in Chinese Arena Football League players [30]. Age and comorbidities, particularly diabetes and cardiovascular conditions, have the greatest effect on readmission and event risk after short stay total hip arthroplasty [58]. Obesity is not associated with increased risk of long-term surgical complications after anatomic or reverse total shoulder arthroplasty when other major comorbidities are controlled for [59]. Diagnosed mental health disorders are associated with increased short- and long-term postoperative complications after anterior cruciate ligament reconstruction [63]. Current comorbidity indices inadequately identify patients who experience early adverse outcomes following total shoulder arthroplasty [70]. Frail women have lower 30-day mortality despite increased complication rates compared to frail men following primary total hip arthroplasty [75]. Patients with a history of solid organ transplant undergoing shoulder arthroplasty have specific vulnerability to minor complications and inherently increased inpatient resource utilization [106].

Recovery

Light activity (weeks): Evidence does not provide specific week ranges for light activity or desk work return across the cited conditions.

Full activity (months): Evidence does not provide specific month ranges for full activity, manual work, or sport return across the cited conditions.

Complete recovery / outcome plateau (months): Evidence does not provide specific month ranges for outcome plateau across the cited conditions.

Rehabilitation protocol: Evidence does not specify PT phasing, immobilisation duration, weight-bearing progression, or sling/brace removal timing.

Functional milestones: Age impacts patient course and outcomes in elective total hip arthroplasties in nonagenarians, regardless of comorbidities [2]. Individuals with at least one previous undiagnosed concussion exhibit worse baseline clinical indicators [3]. Geriatric hip fractures are associated with high short-term morbidity and mortality [8]. Obesity is associated with lower long-term functional outcomes and higher complication rates following total hip arthroplasty [10]. Implant survival following total hip arthroplasty remains comparable between obese and non-obese patients [10]. Dependent functional status is a risk factor for perioperative and postoperative complications after total hip arthroplasty [19]. A higher Charlson comorbidity index is associated with worse patient function and a higher long-term risk of death in elderly patients with femoral neck fractures [21]. Long-term anticoagulation use is associated with poorer medical and surgical outcomes at both 90 days and 2 years postoperatively in patients undergoing unicompartmental knee arthroplasty [22]. Morbid obesity (BMI ≥ 35 kg/m²) is an independent risk factor for functional outcomes and implant survival after unicompartmental knee arthroplasty [23]. Functional outcomes increase after different secondary procedures for brachial plexus birth palsy, even in the long term [48]. Results of contralateral lower trapezius transfer for restoration of shoulder external rotation in traumatic brachial plexus palsy remained stable after a mean follow-up of 58 months with no donor site deficit [86].

Other Considerations: Understanding injury epidemiology, including return to play rates and career duration, allows treating physicians to gain player trust, understand prognosis, and guide players back to the field safely [17]. A history of anterior cruciate ligament reconstruction is a risk factor for further injury, with the highest risk occurring in the first year after reconstruction [25]. Years of experience was the only factor associated with severe injuries in Chinese Arena Football League players [30]. The risk of Osgood-Schlatter disease is greater in stage A than stage C and in stage E than stage A [31]. The risk of Osgood-Schlatter disease increases with age in males but not in females [31]. Male and nonwhite patients are at increased risk of loss to follow-up for patient-reported outcomes at 2 years after anterior cruciate ligament reconstruction [88]. Education level did not predict loss to follow-up for patient-reported outcomes at 2 years after anterior cruciate ligament reconstruction [88]. Prolonged return to sport time in high school athletes with acute sport-related concussion is associated with athletic trainer involvement, sex, concussion history, and location of follow-up care [117]. Parsonage-Turner syndrome generally resolves over time, with a recovery rate of 65% at 10 months and a favorable prognosis for most cases [118]. Recurrences of Parsonage-Turner syndrome are noted, especially in patients with a genetic predisposition [118].

Key Evidence

• [L3] Age at index arthroplasty affects outcomes and the risk of revision. (10.1016/j.jse.2019.09.016)
• [L2] Surgeons and patients must consider the impact of age on patient course and outcomes regardless of the presence of comorbidities. (10.1016/j.arth.2022.01.067)
• [L3] Individuals reporting at least 1 previous undiagnosed concussions exhibited worse baseline clinical indicators. (10.1177/03635465221118089)
• [L4] We cannot recommend a specific BMI threshold to utilize as a screening for postoperative complications but rather emphasize incorporating BMI as a component of the comprehensive preoperative clinical assessment. (10.1016/j.arth.2024.10.040)
• [L3] Advanced age should not be used as the sole determinant of perioperative survival, and postoperative survival justifies the resources utilized in revision surgery regardless of age. (10.1016/j.arth.2008.11.099)
• [L2] Greater diagnosis severity at presentation may affect outcomes afforded by surgery and pose a higher risk of postoperative complications. (10.5435/jaaos-d-25-00064)
• [L5] This article aims to review the epidemiology, etiology, relevant anatomy, clinical presentations, diagnosis, and management of thoracic outlet syndrome, noting that while consensus in diagnostic criteria has not yet been established, general first-line therapy is conservative treatment and surgery is considered for patients who fail conservative therapy. (10.3390/jcm10050962)
• [L3] Geriatric hip fractures continue to have high short-term morbidity and mortality. (10.5435/jaaos-d-21-01055)
• [L3] Complication rates were similar between the age groups. (10.1002/ksa.12596)
• [L2] Obesity is associated with lower long-term functional outcomes and higher complication rates following total hip arthroplasty, though implant survival remains comparable to non-obese patients. (10.1186/1749-799x-7-16)
• [L3] The use of eligibility criteria for primary TSA or RSA based solely on BMI threshold values presents a potential limitation in access to care to these patients who otherwise would have a complication-free procedure. (10.5435/jaaos-d-21-00476)
• [L3] Additional investigations are indicated in identifying at-risk patients and subsequent optimization of these patients. (10.5435/jaaos-d-23-00368)
• [L3] We recommend individualized risk stratification and early anticoagulation for patients with risk factors (age ≥ 65 years, D-dimer > 0.5 mg/L and albumin < 35g/L). (10.1186/s13018-021-02558-4)
• [L3] Understanding how the accuracy of diagnostic tests varies with respect to demographic factors can help physicians avoid subjecting patients to unnecessary additional testing and reach more accurate diagnoses of PJI. (10.1016/j.arth.2020.10.036)
• [L3] Complication patterns varied by diagnostic cluster, with the highest revision risk observed in patients with schizophrenia spectrum disorders (F20 to F29) and extrapyramidal/parkinsonian disorders (G20 to G26). (10.1016/j.arth.2025.11.002)
• [L4] The HITS database provides the most comprehensive epidemiologic resource on injuries in professional baseball, identifying high-risk conditions and characterizing management outcomes. (10.1177/23259671261419846)
• [L5] Understanding injury epidemiology, including data on return to play rates and career duration, allows treating physicians to gain player trust, understand prognosis, and properly guide players back to the field safely. (10.1016/j.arthro.2023.01.097)
• [L4] The authors propose modern comprehensive diagnostic criteria based on existing literature and current findings. (10.1186/s42836-021-00107-2)
• [L3] These data may aid for patient counseling and risk stratification. (10.1016/j.arth.2018.12.037)
• [L2] Patients identified as being at higher risk (in ASA class 3 or 4) preoperatively should be closely managed medically so that perioperative medical complications can be managed and evolving medical issues can be addressed in a timely fashion. (10.2106/jbjs.i.00571)
• [L3] The higher the CCI, the worse the patient's function and the higher the long-term risk of death. (10.1186/s12891-024-07814-2)
• [L3] This study demonstrated that long-term anticoagulation use was associated with poorer medical and surgical outcomes at both 90 days and 2 years postoperatively in patients undergoing UKA, even after rigorous adjustment for confounders. (10.1016/j.arth.2024.02.021)
• [L3] Morbid obesity is an independent risk factor for functional outcomes and implant survival after UKA. (10.1186/s13018-019-1316-5)
• [L2] A history of anterior cruciate ligament reconstruction is a risk factor for further injury, with the highest risk in the first year after reconstruction. (10.1177/03635465010290021301)
• [L3] Controlling for comorbidities and known risk factors for instability, the analysis demonstrated no difference in rates of dislocation or revision for instability between normal-weight patients and those in higher BMI classes. (10.1016/j.arth.2024.03.023)
• [L3] This study provides information to determine the prevalence of these anatomic variants in the general population. (10.1177/2325967120977892)
• [L2] Years of experience was the only factor that was associated with severe injuries. (10.1177/2325967118780040)
• [L3] The risk of OSD is greater in stage A than stage C and in stage E than stage A, with the risk increasing with age in males but not in females. (10.1177/2325967117749184)
• [L4] Temporal and kinematic motions at the shoulder were prominent predictors of shoulder anterior force for both cohorts. (10.1177/17585732221098721)
• [Paper] Understanding the biomechanics of the kinetic chain is fundamental for evaluating and treating the athlete's shoulder, as disruption of this mechanism predisposes athletes to injury. (10.1016/j.csm.2008.07.007)
• [L3] Therefore, when UKA is used for appropriate indications, high BMI should not be considered a contraindication. (10.1007/s00167-018-5218-6)
• [L3] Age, race, insurance status, surgical indication, and number of spinal levels included in the arthrodesis were also associated with reoperation risk. (10.2106/jbjs.15.00938)
• [L3] These identified risk factors aid in patient counseling, individualized risk assessment and risk stratification, and should be kept in mind. (10.1186/s12891-021-04145-4)
• [L4] There are 16 categories within the FEDS classification that are clinically significant. (10.1016/j.jse.2018.08.014)
• [L4] Multiple upper extremity and trunk kinematic parameters affect ball velocity, with significant contributions from the throwing shoulder and trunk, as well as nondominant arm. (10.1177/23259671231196539)
• [L4] The institution of BMI eligibility cutoffs would result in low PPVs and a high number of denials for surgery that would otherwise be complication free. (10.1016/j.arthro.2019.06.039)
• [L3] Obesity alone should not preclude patients from TSA eligibility, as surgical candidacy should be evaluated in the context of patients' overall health. (10.5435/jaaos-d-23-00122)
• [L3] Standardized preoperative protocols should be developed and instituted to improve outcomes in this patient cohort. (10.5435/jaaos-d-22-00214)
• [L3] THA candidates with a high comorbidity burden may benefit from referral to high-volume surgeons to reduce procedural risk and improve postoperative outcomes. (10.1302/0301-620x.106b3.bjj-2023-0807.r1)
• [L3] Certain variables were associated with increased symptoms across multiple clusters and may be indicative of greater injury severity, while other factors were associated with a more specific symptom presentation. (10.1177/23259671231163581)
• [L5] The report highlights that while many concussions are mild, they are a form of traumatic brain injury with a wide range of severity, and early detection through thorough knowledge of signs and symptoms is critical for management. (10.1177/03635465990270052401)
• [L3] Additionally, independent predictors of early revision include obesity and a diagnosis of anxiety/depression. (10.1016/j.arth.2018.01.018)
• [L1] The literature reveals that functional outcome increases after different secondary procedures, even in the long term. (10.1302/0301-620x.105b4.bjj-2022-1069.r1)
• [L3] Concussions were the most common injury diagnosis, had the worst return-to-play outcomes among common diagnoses, and were mostly sustained outside of competition. (10.1177/23259671221110208)
• [L3] The risk of 30-day readmission and overnight hospital stay increased with patient age. (10.1016/j.jse.2020.05.024)
• [L2] However, these factors were not associated with patient-reported outcomes after intervention. (10.1007/s11999.0000000000000087)
• [L4] Several results differed from those of previous studies with adult pitchers: pitch speed remained steady, shoulder maximum internal rotation velocity increased, and shoulder kinetics increased during a simulated game. (10.1177/2325967118765655)
• [L4] The consistency in kinematics demonstrates that despite completing 105 pitches, these athletes are able to maintain shoulder kinematics and ball speed during the underhand pitch. (10.1177/2325967113s00094)
• [L5] The critical shoulder angle was unaffected by demographic factors. (10.1016/j.jse.2014.10.021)
• [Paper] Optimum restoration of shoulder function requires activation of all kinetic chain segments to re-establish the interactions that existed before injury. (10.1016/j.csm.2008.07.001)
• [L3] Across all model timeframes, rTSA consistently yielded greater quality-adjusted life years and superior cost-effectiveness, supporting its role as the preferred treatment strategy in this population. (10.1016/j.jse.2026.04.004)
• [L4] These results suggest that players can throw at close to half effort to reduce their elbow kinetics while maintaining kinematics that would be occurring at 100% effort pitching. (10.1177/23259671251356631)
• [L3] Obesity, when other major comorbidities are controlled for, was not associated with increased risk of long-term surgical complications after shoulder replacement surgery. (10.1016/j.jse.2022.10.013)
• [L4] Risk factors for overall failure included age less than 30 years, female sex, and tobacco use, while surgical and overall failures were associated with periosteal patch use. (10.1177/0363546518800713)
• [L2] However, conservative management should be considered before surgical treatment is indicated. (10.1186/s13018-022-03376-y)
• [L3] Diagnosed mental health disorders were associated with increased short- and long-term postoperative complications after ACL reconstruction but also demonstrated a potentially protective association with multiple postoperative outcomes, including decreased odds of additional ACL tears and reconstructions. (10.1016/j.arthro.2025.05.037)
• [L4] Alternatively, no relationship was found between the other stride parameters (stride position and stride-foot progression angle) and shoulder distraction force. (10.1177/23259671241280233)
• [L4] Although the pitching kinematics and kinetics in young female players were significantly lower than those in young male players, the pitching kinematics and kinetics that cause increases in the elbow joint load had a sex difference, and those in young female players depended on shoulder kinematics. (10.1177/23259671251343795)
• [L3] Although long-term revision rates following total hip replacement were higher among obese patients, we believe that the rates remained acceptable by contemporary standards and were balanced by a lower risk of 90-day mortality. (10.2106/jbjs.18.00120)
• [L5] Shoulder muscle imbalance alone causes neither subscapularis shortening nor internal rotation contracture. (10.2106/jbjs.j.00943)
• [L3] An optimized logistic regression model achieved an AUC of 0.934, indicating clinical relevance and effectiveness for predicting risk factors. (10.1002/ksa.12372)
• [L3] Current comorbidity indices inadequately identify patients who experience early adverse outcomes following total shoulder arthroplasty. (10.5397/cise.2025.00584)
• [L4] Serratus anterior reconstruction is recommended to achieve optimal shoulder function. (10.1016/j.hcl.2015.12.004)
• [L3] Optimizing preoperative kidney function through appropriate interventions might decrease the risk of poor prognosis in this population. (10.1186/s12891-024-07653-1)
• [L3] The results are durable with successful outcomes observed at nine years following surgery. (10.1016/j.arthro.2014.04.059)
• [L4] This technique can provide shoulder abduction and shoulder extension, which are the functions of the posterior deltoid muscle. (10.1016/j.jhsa.2022.04.022)
• [L3] Contrarily, frail women, relative to frail men, have lower 30-day mortality despite increased complication rates. (10.1016/j.arth.2023.01.054)
• [L3] Given the considerable impact of PAD on TKA outcomes, comprehensive management strategies are crucial to mitigate adverse events, underscoring the need for further research to explore risk stratification and targeted interventions for improved TKA safety in patients who have PAD. (10.1016/j.arth.2024.11.047)
• [L3] The incidence of pathology identified on knee MRI scans in players at the NBA Draft Combine without clinical symptoms was high, with little correlation found between objective imaging findings and subjective pain, function, and orthopaedic injury history. (10.1177/03635465251381362)
• [L4] Sagittal plane positioning of the trunk plays a role in pitching mechanics, as it can affect both pitching performance and elbow moments. (10.1177/2325967118800240)
• [L3] Biomechanical risk factors were less commonly reported and lack sufficient evidence to recommend preventative strategies. (10.1136/jisakos-2018-000226)
• [L3] Overhead athletes, regardless of shoulder injury history, demonstrated similar kinetic chain sequencing across lower limb and lumbopelvic-hip complex segments, with differences only in the timing of peak elbow extension and shoulder flexion angular velocities. (10.1177/23259671241288889)
• [L4] Arm slot position was related to shoulder abduction and trunk lateral tilt. (10.1177/23259671221147874)
• [L4] Shoulder internal/external rotation in abduction and adduction is not interchangeable. (10.1016/j.jhsa.2024.06.001)
• [L3] Validation of this finding in studies with imaging data to confirm diagnoses will be an important next step. (10.2106/jbjs.20.01474)
• [L4] Numerous scoring systems have been devised to evaluate patients who have symptoms related to the knee, but demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores. (10.2106/00004623-199706000-00009)
• [L4] The results have remained stable after mean follow-up of 58 months with no donor site deficit. (10.1177/1753193413512245)
• [L2] While education level did not predict loss to follow-up, patients who are male and nonwhite are at increased risk of loss to follow-up of PROM at 2 years. (10.1177/0363546519876925)
• [L3] These factors are considered refractory to conservative management and may indicate a need for UCL reconstruction surgery. (10.1177/2325967113s00015)
• [L2] The excess of knee ROA among symptomatic males in this study seems unlikely to be attributable to the use of comprehensive X-ray views. (10.1186/1471-2474-9-82)
• [L4] Categorizing KL stages into early (KL≤2) and advanced (KL≥3) groups improved interobserver reliability, thereby facilitating the development of standardized AI datasets. (10.1186/s13018-025-06057-8)
• [L2] The odds of developing PPCS increases with each point increase on the risk score. (10.1177/2325967121s00394)
• [L3] MRI defined patellar tendinopathy is common in community-based adults and is associated with current and past history of obesity assessed by BMI or body weight, but not fat mass. (10.1186/1471-2474-15-266)
• [L4] This review provides an evidence-based systematic approach for directing patients to preoperative imaging, grading and classifying injuries using established radiological criteria, selecting patients for nonoperative treatment, and referring them appropriately for operative management. (10.1302/0301-620x.102b10.bjj-2020-1210.r1)
• [L3] Those with prior shoulder surgery additionally had more diagnostic imaging and orthopaedic surgery in college. (10.1177/2325967115s00149)
• [L4] This analysis demonstrates a significant decrease in the initial trial of nonoperative treatment and an increase in the rate of surgery. (10.1016/j.jse.2016.05.001)
• [L3] The clinical and radiological outcomes in patients with preoperative overweight, obesity, and normal-BMI were not significantly different. (10.1371/journal.pone.0280687)
• [L4] Socioeconomically disadvantaged and non-White patients who sustain ACL tears are at a greater risk of delays in the time of injury to ACLR and for undergoing a concomitant meniscectomy. (10.1016/j.arthro.2024.10.019)
• [L3] Nonagenarian patients with hip fracture differ significantly from younger patients concerning clinical characteristics, medical complications, and in-hospital and 30-day mortality rates. (10.1016/j.arth.2019.12.044)
• [L2] Radiographical parameters that stratify risk of recurrent patellar dislocation in adults are also able to predict recurrent patellar dislocation in the pediatric population. (10.1136/jisakos-2020-000461)
• [L4] MRI determination of PIN position is reliable and consistent with prior cadaveric study. (10.1016/j.arthro.2020.12.118)
• [L3] Patients with history of solid organ transplant undergoing shoulder arthroplasty appear to remain a unique population due to their specific vulnerability to minor complications and inherently increased inpatient resource utilization. (10.1016/j.jse.2018.02.064)
• [L2] Evaluation of fall risk factors contributes to identifying patients with bone risk factors at highest immediate risk of subsequent non-vertebral fracture despite guideline-based treatment. (10.1186/1471-2474-14-121)
• [L3] DTI with a cutoff of 1.6 may help prompt clinicians to initiate workup and thus manage underlying osteoporosis. (10.1016/j.jse.2024.05.018)
• [L4] Knee pain scores increased ability to identify participants with radiographic KL ≥ 2 in both sexes. (10.1186/1471-2474-14-214)
• [L3] Additionally, opioid users had significantly increased rates of periprosthetic radiolucency and revision. (10.1016/j.jse.2021.07.027)
• [L3] This cohort of Canadian patients aged > 65 years who experienced a fragility fracture at any site are at imminent risk of experiencing subsequent fracture within the next 2 years and should be proactively assessed and treated. (10.1186/s12891-021-04051-9)
• [L4] Re‐revision beyond 5 years is uncommon. (10.1002/ksa.70190)
• [L3] Younger patients, particularly those ≤15 and 16 to 20 years of age, were more likely to have experienced multiple instability events at the time of initial evaluation, require surgery, and experience recurrent instability compared with older patients. (10.1177/0363546519886861)
• [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
• [L4] There was an association between prolonged RTS and AT involvement, sex, concussion history, and location of follow-up care. (10.1177/03635465231219263)
• [L5] The condition generally resolves over time, with a recovery rate of 65% at 10 months and a favorable prognosis for most cases, though recurrences are noted, especially in patients with a genetic predisposition. (10.5397/cise.2025.00885)

See Also

• Clinical Assessment
• Shoulder Instability
• Rotator Cuff
• Total shoulder arthroplasty
• Fractures
• Shoulder Arthroplasty

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