Demographics & Risk

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

Overview

Age significantly influences patient course and outcomes across multiple arthroplasty procedures. In elective total hip arthroplasty, age impacts outcomes in nonagenarians regardless of comorbidities [1], while age at index arthroplasty affects outcomes and revision risk in shoulder arthroplasty [2]. Advanced age should not serve as the sole determinant of perioperative survival in revision joint arthroplasty, as postoperative survival justifies resource utilization regardless of age [6]. Similarly, complication rates for proximal hamstring avulsion surgery are similar between patients under and over 50 years old, though younger patients experience greater functional gains [10].

Body mass index (BMI) thresholds should not be used as standalone screening tools for postoperative complications in primary total knee or total hip arthroplasty; BMI must be incorporated into comprehensive preoperative clinical assessment [5]. Relying solely on BMI eligibility criteria for primary total shoulder arthroplasty limits access to care for patients who would otherwise have complication-free procedures [12]. Institution of BMI cutoffs in knee arthroscopy yields low positive predictive values and high denial rates for otherwise uncomplicated surgeries [40]. Conversely, underweight BMI is associated with increased in-hospital complications and length of stay after revision total joint arthroplasty, necessitating standardized preoperative protocols to improve outcomes in this population [42].

Other demographic factors also drive risk stratification. Age, race, insurance status, surgical indication, and the number of spinal levels in arthrodesis are 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 and improve outcomes [43]. In hip resurfacing arthroplasty, gender has no appreciable effect on implant survivorship [44]. Women remain excellent candidates for this procedure if optimized surgical technique offsets risks associated with small component size [44].

Anatomy & Pathophysiology

Kinematics and Kinetics

Shoulder injury risk and performance are heavily influenced by kinetic chain mechanics and throwing parameters. Disruption of the kinetic chain mechanism predisposes athletes to shoulder injury [33]. Optimum restoration of shoulder function requires activation of all kinetic chain segments to re-establish pre-injury interactions [55]. 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 windmill softball pitches are able to maintain shoulder kinematics and ball speed during the underhand pitch [53].

Specific kinematic variables modulate joint loads. Players can throw at close to half effort to reduce elbow kinetics while maintaining kinematics occurring at 100% effort pitching [57]. No relationship was found between stride position, stride-foot progression angle, and shoulder distraction force in collegiate softball pitchers [64]. 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 [82]. 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, with differences only in the timing of peak elbow extension and shoulder flexion angular velocities [81].

Osseous and Structural Morphology

Structural anatomy defines baseline risk and functional capacity. The critical shoulder angle is unaffected by demographic factors [54]. Rotator cuff disease natural history involves comparing morphological characteristics and prevalences in asymptomatic and symptomatic shoulders [4]. Increased pitch velocity and workload are common risk factors for ulnar collateral ligament injury in baseball players [79].

Neural and Muscular Function

Neural integrity and muscle balance are critical for shoulder stability and function. Shoulder muscle imbalance alone causes neither subscapularis shortening nor internal rotation contracture following neonatal brachial plexus injury [68]. Shoulder internal/external rotation in abduction and adduction is not interchangeable in children with brachial plexus birth injury [83]. 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 provides shoulder abduction and shoulder extension functions of the posterior deltoid [74].

Classification

FEDS: The FEDS system classifies glenohumeral instability into 16 clinically significant categories [38].

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

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

Other Considerations: Age at index arthroplasty affects outcomes and the risk of revision [2]. 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) [16].

Clinical Presentation

Diagnostic Criteria and Severity Assessment: Consensus on diagnostic criteria for thoracic outlet syndrome has not yet been established [8]. For rapidly progressive osteoarthritis of the hip, modern comprehensive diagnostic criteria have been established and validated in the Southeast Asian population [19]. In neuromuscular scoliosis, greater diagnosis severity at presentation may affect surgical outcomes and pose a higher risk of postoperative complications [7]. Concussions represent a form of traumatic brain injury with a wide range of severity, where 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 a more specific symptom presentation [45].

Preoperative Risk Stratification and Demographics: Age impacts patient course and outcomes in elective total hip arthroplasty, independent of comorbidities [1]. The risk of 30-day readmission and overnight hospital stay after shoulder instability surgery increased with patient age [50]. Dependent functional status is a risk factor for perioperative and postoperative complications after total hip arthroplasty [20]. Patients identified as being at higher risk (ASA class 3 or 4) preoperatively should be closely managed medically to manage perioperative medical complications and address evolving medical issues [21]. Independent predictors of early revision total hip arthroplasty include obesity and a diagnosis of anxiety/depression [47]. 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 [13].

Infection and Thromboembolic Markers: The accuracy of inflammatory biomarkers in diagnosing periprosthetic joint infection varies significantly among demographic groups [15]. Individualized risk stratification and early anticoagulation are recommended for closed patella fracture patients with risk factors including age ≥ 65 years, D-dimer > 0.5 mg/L, and albumin < 35g/L [14]. 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 and Epidemiology: Complication patterns in knee arthroplasty 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) [16]. The HITS database identifies high-risk conditions and characterizes management outcomes for injuries in professional baseball [17]. 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 [18]. 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].

Investigations

Plain radiography: Modern comprehensive diagnostic criteria for rapidly progressive osteoarthritis of the hip have been established and validated in the Southeast Asian population [19]. The prevalence of morphological variations associated with femoroacetabular impingement has been determined in the general population based on a study of 1878 asymptomatic hips in nonprofessional athletes [29]. Knee pain scores increased ability to identify participants with radiographic Kellgren-Lawrence grade ≥ 2 in both sexes [109]. The excess of knee radiographic osteoarthritis among symptomatic males seems unlikely to be attributable to the use of comprehensive X-ray views [90]. Registry studies cannot adjust for lesional determinants of prognosis and should be interpreted with caution to avoid depriving patients from safe and simple treatments to delay or circumvent surgery [32].

MRI: The incidence of pathology identified on knee MRI scans in players at the NBA Draft Combine without clinical symptoms was high [77]. Little correlation was found between objective imaging findings and subjective pain, function, and orthopaedic injury history in players at the NBA Draft Combine [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 of neuromuscular scoliosis at presentation may affect outcomes afforded by surgery and pose a higher risk of postoperative complications [7]. Additional investigations are indicated in identifying at-risk patients and subsequent optimization of these patients [13]. 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 periprosthetic joint infection [15]. 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]. The risks of corticosteroids could be mitigated using radiographically guided infiltration and, ultimately, by rapid surgical repair in young patients [32].

Preoperative Risk Stratification: Those with prior shoulder surgery had more diagnostic imaging and orthopaedic surgery in college [99]. Preoperative opioid usage predicts markedly inferior outcomes 2 years after reverse total shoulder arthroplasty [110]. Opioid users had significantly increased rates of periprosthetic radiolucency and revision after reverse total shoulder arthroplasty [110]. Re-revision beyond 5 years is uncommon following revision knee arthroplasty in the elderly [112].

Demographic & Clinical Correlates: There was no difference in clinical, functional, or radiological outcomes between obese and non-obese patients [96]. The clinical and radiological outcomes in patients with preoperative overweight, obesity, and normal-BMI were not significantly different following open-wedge high tibial osteotomy [101]. A deltoid tuberosity index cutoff of 1.6 may help prompt clinicians to initiate workup and thus manage underlying osteoporosis in an Asian population [108]. Bisect offset ratio and cartilaginous sulcus angle are good combined predictors of recurrent patellar dislocation in children and adolescents [104]. Radiographical parameters that stratify risk of recurrent patellar dislocation in adults are also able to predict recurrent patellar dislocation in the pediatric population [104]. 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 in hamstring injuries [98].

Treatment

Non-Operative

Conservative management serves as the general first-line therapy for thoracic outlet syndrome, with surgery reserved for patients who fail this approach [8]. Similarly, conservative management should be considered prior to surgical indication for pubalgia in athletes [62]. For elbow epicondylitis, radiofrequency microtenotomy yields durable results, with successful outcomes observed at nine years following surgery [73]. Operative management of unspecified conditions resulted in 84% excellent-to-good results, compared to 59% for non-operative management and 42% for referral for poor results [97]. There has been 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 [2]. 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 [6]. Reverse total shoulder arthroplasty (rTSA) yielded greater quality-adjusted life years and superior cost-effectiveness compared to other strategies, supporting its role as the preferred treatment strategy for proximal humerus fractures in patients over 65 years old [56]. Nonagenarian patients with hip fracture differ significantly from younger patients concerning clinical characteristics, medical complications, and in-hospital and 30-day mortality rates [103]. Risk factors for overall failure of autologous chondrocyte implantation and tibial tubercle osteotomy for patellofemoral chondral defects included age less than 30 years, female sex, and tobacco use [60]. Factors considered refractory to conservative management of ulnar collateral ligament (UCL) injuries in baseball players may indicate a need for UCL reconstruction surgery [89].

Patient Selection & Risk Stratification: A specific BMI threshold should not be used as a screening for postoperative complications; BMI should be incorporated as a component of comprehensive preoperative clinical assessment [5]. The use of eligibility criteria for primary total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RSA) based solely on BMI threshold values presents a potential limitation in access to care [12]. Morbid obesity (BMI ≥ 35 kg/m2) is an independent risk factor for functional outcomes and implant survival after unicompartmental knee arthroplasty (UKA) [24]. When UKA is used for appropriate indications, high BMI should not be considered a contraindication [34]. Obesity does not appear to be a contraindication to UKA as long as other patient selection criteria are adhered to [35]. Obesity alone should not preclude patients from TSA eligibility, as surgical candidacy should be evaluated in the context of patients' overall health [41]. Individualized risk stratification and early anticoagulation are recommended for patients with risk factors for preoperative deep venous thrombosis, including age ≥ 65 years, D-dimer > 0.5 mg/L, and albumin < 35g/L [14]. Comprehensive management strategies are crucial to mitigate adverse events and improve total knee arthroplasty (TKA) safety in patients with peripheral artery disease (PAD) [76]. 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]. 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]. Socioeconomically disadvantaged and non-White patients who sustain ACL tears are at a greater risk of delays in the time of injury to ACL reconstruction and for undergoing a concomitant meniscectomy [102].

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, and these patients were significantly more dissatisfied with their operation [92].

Complications

Other Considerations:

Age and Frailty: Age significantly impacts patient course and outcomes in elective total hip arthroplasty (THA) for nonagenarians, independent of comorbidities [1]. In geriatric hip fractures, high short-term morbidity and mortality are associated with this demographic [9]. For elderly patients with femoral neck fractures, a higher Charlson comorbidity index (CCI) correlates with worse function and increased long-term mortality risk [22]. Following primary THA, frail women exhibit lower 30-day mortality despite higher complication rates compared to frail men [75]. In anterior shoulder instability, younger patients (≤15 and 16–20 years) face higher rates of multiple instability events, surgical requirement, and recurrence compared to older cohorts [113]. Patients aged >65 years with a fragility fracture are at imminent risk of subsequent fracture within two years [113].

Obesity: Obesity is linked to lower long-term functional outcomes and higher complication rates after THA, though implant survival remains comparable to non-obese patients [11]. Long-term revision rates for THA are higher in obese patients but remain acceptable by contemporary standards; this elevated revision risk is balanced by a lower 90-day mortality rate [67]. Conversely, obesity does not increase the risk of long-term surgical complications after anatomic or reverse total shoulder arthroplasty when major comorbidities are controlled [59].

Comorbidities and Medical History: Age and comorbidities, specifically diabetes and cardiovascular conditions, exert the greatest influence on readmission and event risk after short-stay THA [58]. Long-term anticoagulation use predicts poorer medical and surgical outcomes at 90 days and 2 years following unicompartmental knee arthroplasty [23]. Diagnosed mental health disorders increase short- and long-term postoperative complications after anterior cruciate ligament (ACL) reconstruction, yet are associated with decreased odds of additional ACL tears and reconstructions [63]. Patients with a history of solid organ transplant undergoing shoulder arthroplasty show specific vulnerability to minor complications and increased inpatient resource utilization [106]. Current comorbidity indices inadequately identify patients at risk for early adverse outcomes following total shoulder arthroplasty [70].

Procedure-Specific Complications: Complication rates for proximal hamstring avulsion surgery are similar between patients under and over 50 years of age [10]. A history of ACL reconstruction is a risk factor for further injury, with the highest risk occurring in the first year post-reconstruction [25]. Major primary complications occur after bipolar radial head arthroplasty, with radiographic signs of degenerative changes appearing in 8.8% of cases at 8.8 years follow-up [114].

Recovery

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

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

Complete recovery / outcome plateau (months): Evidence does not provide specific month ranges for complete recovery or outcome plateau across the included studies.

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 arthroplasty for nonagenarians, regardless of comorbidities [1]. 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 [9]. Obesity is associated with lower long-term functional outcomes and higher complication rates following total hip arthroplasty, while implant survival remains comparable to non-obese patients [11]. Dependent functional status is a risk factor for perioperative and postoperative complications after total hip arthroplasty [20]. 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 [22]. 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, even after adjustment for confounders [23]. Morbid obesity (BMI ≥ 35 kg/m2) is an independent risk factor for functional outcomes and implant survival after unicompartmental knee arthroplasty [24]. Functional outcome increases 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 [18]. 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 the Chinese Arena Football League [30]. The risk of Osgood-Schlatter disease is greater in stage A than stage C and in stage E than stage A, with risk increasing with age in males but not in females [31]. Registry studies cannot adjust for lesional determinants of prognosis and should be interpreted with caution to avoid depriving patients of safe treatments to delay or circumvent surgery; risks of corticosteroids could be mitigated using radiographically guided infiltration and rapid surgical repair in young patients [32]. 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]. The study provides prognostic data regarding expected time loss on a per-injury pattern basis for hand and wrist injuries in NCAA men’s football [115]. Rhabdomyosarcoma of the hand is a uniformly fatal disease regardless of treatment in patients with complete follow-up [116]. Parsonage-Turner syndrome 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 [117].

Key Evidence

• [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] Age at index arthroplasty affects outcomes and the risk of revision. (10.1016/j.jse.2019.09.016)
• [L3] Individuals reporting at least 1 previous undiagnosed concussions exhibited worse baseline clinical indicators. (10.1177/03635465221118089)
• [L3] The study provides insight into the natural history of rotator cuff disease by comparing morphological characteristics and prevalences in asymptomatic and symptomatic shoulders. (10.2106/jbjs.e.00835)
• [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] 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)
• [Commentary] Registry studies cannot adjust for lesional determinants of prognosis and should be interpreted with caution to avoid depriving patients from safe and simple treatments to delay or circumvent surgery; the risks of corticosteroids could be mitigated using radiographically guided infiltration and, ultimately, by rapid surgical repair in young patients. (10.1016/j.arthro.2018.10.009)
• [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] 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] 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] This study provides valuable prognostic data regarding expected time loss on a per-injury pattern basis. (10.1177/2325967119835375)
• [L4] In patients with complete follow-up, it has been a uniformly fatal disease regardless of treatment. (10.2106/00004623-196143050-00007)
• [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

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

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