Anatomic total shoulder arthroplasty is the gold standard shoulder replacement procedure for patients with an intact rotator cuff and sufficient glenoid bone to accommodate prosthetic glenoid implant and offers reliable patient satisfaction, excellent implant longevity, and a low incidence of complications. Disparity exists in the literature regarding rehabilitation strategies following anatomic total shoulder arthroplasty. This article presents a consensus statement from experts in the field on rehabilitation following anatomic total shoulder arthroplasty. The goal of this consensus statement is to provide a current evidence-based foundation to inform the rehabilitation process after anatomic total shoulder arthroplasty. These guidelines apply to anatomic total shoulder arthroplasty (replacement of the humeral head and glenoid), hemiarthroplasty (replacing only the humeral head), and hemiarthroplasty with glenoid reaming or resurfacing. The consensus statement integrates an extensive literature review, as well as survey results of the practice patterns of members of the American Society of Shoulder and Elbow Therapists and the American Shoulder and Elbow Surgeons. Three stages of recovery are proposed, which initially protect and then gradually load soft tissue affected by the surgical procedure, such as the subscapularis, for optimal patient outcomes. The proposed guidelines should be used in collaboration with surgeon preferences and patient-specific factors.

BACKGROUND: The purpose of this study was to survey trauma and arthroplasty surgeons to investigate associations between subspecialty training and management of geriatric femoral neck fractures and to compare treatments with the American Academy of Orthopaedic Surgeons clinical practice guidelines.
METHODS: Five hundred fifty-six surgeons completed the online survey consisting of two sections: (1) surgeon demographics and (2) two geriatric hip fracture cases with questions regarding treatment decisions.
RESULTS: In both clinical scenarios, arthroplasty surgeons were more likely than trauma surgeons to recommend total hip arthroplasty (THA) (case 1: 96% versus 84%; case 2: 29% versus 10%; P ≤ 0.02) and spinal anesthesia (case 1: 70% versus 40%; case 2: 62% versus 38%; P < 0.01). Surgeons who have made changes based on clinical practice guidelines (n = 96; 21% of surveyed) cited more use of THA (n = 56; 58% of respondents) and cemented stems (n = 28; 29% of respondents).
CONCLUSIONS: Arthroplasty surgeons are more likely to recommend THA over hemiarthroplasty and have a higher expectation for spinal anesthesia for the management of geriatric femoral neck fractures.

UNASSIGNED: Metastatic disease involving the femoral head and neck is often treated with a hemiarthroplasty or total hip arthroplasty (THA) to prevent pathologic fracture but there are no outcome studies demonstrating superiority of one option over the other.
UNASSIGNED: This investigation was designed as a survey of the current members of the Musculoskeletal Tumor Society (MSTS). The survey contained seven clinical vignettes with identical imaging of a pathologic lesion of the femoral head and neck. The primary outcome measured was decision to treat the lesion with hemiarthroplasty or THA. Secondary outcomes included method of fixation of the femoral/acetabular components and head type utilized.
UNASSIGNED: A total of 93 members (30.0%) of the MSTS completed the survey. Across all clinical vignettes, 73.3% (p < 0.001) of the responses were in favor of hemiarthroplasty; however, there was no significant difference between hemiarthroplasty and THA in Cases 1 & 2 (p = 0.08, p = 0.6, respectively); the cases representing younger patients with a more favorable histologic diagnosis. When THA was selected the majority of respondents preferred hybrid or cementless fixation construct (56.1% and 27.0%, respectively, p < 0.001). When hemiarthroplasty was selected respondents selected a cemented, bipolar construct (86.4% and 64.2%, respectively, p < 0.001).
UNASSIGNED: When treating metastatic lesions of the femoral head and neck orthopaedic oncologists do not agree on reconstructing with THA versus hemiarthroplasty for patients with younger age and favorable histology. This investigation highlights the controversy of this clinical decision and indicates the need for a collaborative prospective trial among this specific patient population in order to determine the optimal treatment method.

Introduction In 2011 the National Institute for Health and Care Excellence (NICE) published guidelines suggesting that clinicians offer total hip replacement (THR) to patients with displaced intracapsular hip fractures who could walk independently outside with no aids or one stick, who are not cognitively impaired and are ASA (American Society of Anesthesiologists) grade ≤2. They also stated that best practice is operating within 36 hours of presentation. This audit aimed to determine whether Scarborough Hospital was following these guidelines and compared the results with the national average. Methods Two years of data (January 2012 - December 2013) were collected retrospectively from Scarborough Hospital\'s hip fracture database on all patients presenting with an intracapsular hip fracture. Data were analysed to determine whether patients who had a THR fulfilled NICE criteria. Furthermore, patients with hemiarthroplasties who were eligible for THRs were identified. Finally, the time to surgery was calculated to examine whether patients receiving THRs waited longer than patients receiving hemiarthroplasties. Results In 2012, 48.6% of all eligible patients received a THR while in 2013 the figure was 55.9%. These percentages are much higher than the national average. However, 36 (53.7%) of the 67 patients who received a THR did not fulfil all the NICE criteria, mainly owing to high ASA grade. The mean time from presentation to theatre for THR was 8 hours and 37 minutes longer for THR patients than for hemiarthroplasty in 2012. This difference was reduced to 2 hours and 12 minutes in 2013. Conclusions Small general hospitals can meet and even exceed the standards regarding treatment strategies for hip factures. However, there is still room for improvement. Departmental training may be useful in achieving this aim. The anaesthetic team should be involved at the earliest opportunity, to help optimise patients preoperatively and determine whether patients listed for THR with higher ASA grades are suitable for this surgery.

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OBJECTIVE: To review the financial aspects of implementing the latest NICE guideline for neck of femur fracture (CG124), which recommends offering Total Hip Replacement (THR) as an alternative to hemiarthroplasty (HA) for patients, who are independently mobile before injury, not cognitively impaired and well enough to tolerate the operation.
METHODS: Between April 2011 and April 2013 data collected from our Hip Fracture database (NHFD) showed that by following the latest NICE guideline (CG124), out of 840 patients, 176 patients (21%) should be considered for THR rather than HA. Individual procedure costs were calculated by considering cost of implants and consumables (extracted from providers\' published catalogues) added to the cost of running operating theatre for each operation. We then used the national tariff for each procedure using relevant HRG codes to calculate the total cost and the income to the Trust.
RESULTS: Our data indicated that by implementing the latest NICE guideline (CG124), 37.1% of patients with intra-capsular fracture neck of femur (IC-NOF fracture) would be eligible for THR rather than HA. Although performing cemented THR was the more expensive procedure, our calculation shows that despite increased cost of performing the operation, Trusts can increase their net income by £300-600 (depending on their market force factor) per patient using correct HRG coding and National Tariff.
CONCLUSIONS: Utilising 2012-13 National Tariff, performing a cemented THR instead of a HA for patients with IC-NOF fracture, as recommended by the latest NICE guideline (CG124) can increase the Trust\'s revenue per patient in a predictable way. This practice not only results in potentially better patient outcomes but also can increase financial reward and potential for reinvestment in all hip fracture units in the UK.