Koray Şahin

Background Pain Neuroscience Education (PNE) aims to reconceptualize pain by addressing its neurophysiological and biopsychosocial dimensions to improve perioperative outcomes. Aim To investigate the effect of preoperative PNE on postoperative pain catastrophizing in patients undergoing upper extremity orthopaedic surgery. Secondary outcomes included preoperative anxiety, pain intensity, central sensitization, upper extremity function, and health-related quality of life. Methods Thirty-three patients were randomized to a PNE group (n = 17), receiving a single session supported by metaphors and visuals, or a control group (n = 16). Both groups received standard preoperative care. Pain catastrophizing was the predefined primary outcome. Anxiety was assessed before and after education, while pain intensity, pain catastrophizing, central sensitization, function, and quality of life were assessed preoperatively and four weeks postoperatively. Results Groups were comparable at baseline. No significant between-group differences were observed in postoperative pain catastrophizing, although both groups demonstrated significant within-group improvements over time. Likewise, preoperative anxiety decreased significantly within the PNE group (p = 0.012), no significant between-group difference was observed. Compared with the control group, participants receiving PNE demonstrated significantly greater improvements in central sensitization (p = 0.004), upper extremity function (p = 0.008), and the physical component of health-related quality of life (p = 0.023) at four weeks after surgery. Conclusion Although PNE did not improve pain catastrophizing, it was associated with greater improvements in central sensitization, function, and physical quality of life. These findings suggest that multi-session or more comprehensive PNE protocols may be needed to achieve meaningful psychological benefits.

Comprehensive Survival Analysis of Reverse Shoulder Arthroplasty: Do Gender, Age, and Surgical Indication Influence Prosthesis Survivorship? - The Medical Bulletin of Haseki

Background/Objectives: Reverse shoulder arthroplasty (RSA) has been widely used for the treatment of shoulder pathologies, particularly rotator cuff tear arthropathy. Currently, it is also increasingly performed for different indications. Like in any arthroplasty procedure, periprosthetic joint infection (PJI) is one of the most concerning complications and may have devastating outcomes. This study aimed to identify risk factors for PJI following RSA. Methods: This retrospective case-control study was conducted with patients who underwent RSA during the study period. Based on PJI occurrence during the follow-up period, patients were divided into two groups: Group I (no infection) and Group II (infection). The relationship between numerous clinical variables and PJI was tested. All variables were initially evaluated through univariate analysis between the two groups, and variables showing significant differences between the two study groups were subjected to multivariate logistic regression analysis to determine independent risk factors. Results: The study included 302 patients, with a mean age of 69.6 ± 10.1 years and a mean follow-up duration of 59.8 ± 24.7 months. During the follow-up period, PJI was not detected in 289 patients (95.7%) (Group I), while 13 patients (4.3%) developed PJI (Group II). Univariate analysis revealed a significant association between preoperative C-reactive protein (CRP) value (p = 0.001) and preoperative diabetes history (p = 0.007) with PJI. Multivariate logistic regression analysis, including these two variables, showed that diabetes was an independent risk factor for PJI development (p = 0.01, odds ratio = 4.85). Preoperative CRP elevation was not observed as an independent risk factor. Conclusions: This study demonstrated a significant association between high preoperative CRP levels and diabetes with PJI. Additionally, the presence of diabetes was identified as an independent risk factor for infection, with a 4.85-fold higher risk of PJI development in patients with a history of diabetes.

Background: Recently, the lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) have been proposed to assess lateralization and distalization in reverse shoulder arthroplasty (RSA). However, there is insufficient evidence about the influence of patient anatomy and prosthesis design on these measurements. This study aims to investigate the impact of patient anatomy and implant design on LSA and DSA measurements and to assess the validity of the previously reported “optimal” ranges for these parameters. Methods: Patients who underwent the RSA procedure using four different prosthetic designs between April 2014 and June 2023 were retrospectively evaluated. Postoperative LSA and DSA measurements were compared according to implant design, preoperative glenoid morphology (Favard classification), and the Hamada grade. The correlation of LSA and DSA with preoperative shoulder anatomy (critical shoulder angle, CSA, and acromial index, AI) was also assessed. Results: In total, 135 shoulders were included in the study, with a mean age of 71.7 ± 7.9 years. The mean LSA was 88.4 ± 11.8° and mean DSA was 40.6 ± 12.5°. According to prosthetic design, both mean LSA and DSA values differed significantly (p < 0.05). Lateralized designs (Groups I and IV) had significantly higher mean LSA values. The Favard classification and Hamada grade of shoulders did not show a significant influence on LSA and DSA measurements (p > 0.05). DSA was observed to be significantly correlated with CSA and AI (p < 0.05; r = −0.27 and −0.189, respectively). Conclusions: Prosthetic design and preoperative shoulder anatomy had a significant influence on LSA and DSA measurements in RSA. Optimal LSA and DSA values may lack validity and reliability and should not be applied to all patients.

Massive irreparable rotator cuff tears represent a marked challenge for shoulder surgeons, particularly in younger patients with a high level of activity, when a reverse shoulder arthroplasty is not a valuable option. Since massive tears have traditionally been attributed to high retear rates, numerous alternative procedures have been proposed such as partial repair, various tendon transfers, superior capsular reconstruction, or repair with different patch augmentation techniques. In recent years, muscle advancement of the rotator cuff, which used to be a historical procedure, has been emphasized again, with several studies reporting promising clinical and structural outcomes for the treatment of irreparable rotator cuff tears. In this technical note, we describe an alternative technique: advancement of the rotator cuff with trapezius reinforcement. This technique includes muscle advancement of the supraspinatus and infraspinatus muscles and an additional augmentation of the infraspinatus muscle using the lower trapezius tendon to enhance the muscular component of the final repair construct and to achieve higher postoperative strength outcomes in massive irreparable posterosuperior rotator cuff tears. Technique Video: video See video under supplementary data.