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Shekhbihi A, Moroder P, Abdalla A, Reichert W, Scheibel M, Masoud M. The acetabularization index: a novel measure of acromial bone loss prior to reverse shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04102-6. [PMID: 39302446 DOI: 10.1007/s00590-024-04102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Acromial stress fractures following reverse shoulder arthroplasty (RSA) have gained attention among specialized surgeons over the past decades craving answers regarding predisposing factors and technical aspects as how to avoid the complication. This study introduces the acetabularization index (AI) for the preoperative estimation of acromial bone loss attributed to acetabularization in cases of cuff tear arthropathy (CTA). METHODS The acromiohumeral interval (AHI), extent of acromial acetabularization (AA), acromial height (AH), and width of acetabularization (r) were measured on preoperative radiographs and two-dimensional computed tomography scans (2D CT) of patients who underwent RSA within the timeline 2019-2023 for CTA. The AI calculatedAI % = AA mm ÷ AH mm . The CTA grade was determined according to the Hamada classification. The AI values on radiographs and 2D CT were compared by a Student's t-test. Possible correlation between the AI and AHI was investigated via Pearson's coefficient. The intraclass correlation coefficient (ICC) was employed to test the interobserver reliability among two independent testers. RESULTS The radiographs and 2D CT scans of thirty-three patients who underwent RSA were analyzed. The mean AHI, AH, AA, r, and AI values on radiographs were 5.5 ± 2 mm, 10 ± 2 mm, 2 ± 2 mm, 30 ± 4 mm, 16 ± 16%, respectively. On 2D CT, the corresponding mean values were 4.7 ± 2.5 mm, 10.8 ± 2.65 mm, 2.45 ± 2.35 mm, and 30 ± 4.5, and 22.3 ± 22%, respectively. There was a statistically significant difference between the AI values on radiographs and 2D CT (P = .000). The Pearson's correlation coefficient demonstrated a negative correlation between AI and AHI (r = - 0.33). Excellent reliability was observed by the ICC values for all parameters in both groups among two testers. CONCLUSION The AI is a reliably measurable tool on radiographs and 2D CT scans; however, the measurements derived from radiographs vary significantly from CT based measurements due to projection restrictions. Grade IVB of the Hamada/Fukuda classification is associated with the highest AI values. Further research is warranted to assess the clinical utility of this index as a predictive tool for postoperative acromial stress fractures.
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Affiliation(s)
- Abdelkader Shekhbihi
- Department of Trauma Surgery, Lörrach District Hospital, Spitalstraße 25, 79539, Lörrach, , Baden-Württemberg, Germany.
| | - Philipp Moroder
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Abdelhady Abdalla
- Department of Trauma Surgery, Lörrach District Hospital, Spitalstraße 25, 79539, Lörrach, , Baden-Württemberg, Germany
| | - Winfried Reichert
- Department of Trauma Surgery, Lörrach District Hospital, Spitalstraße 25, 79539, Lörrach, , Baden-Württemberg, Germany
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Campus Virchow, Berlin, Germany
| | - Mohammad Masoud
- Department of Trauma Surgery, Lörrach District Hospital, Spitalstraße 25, 79539, Lörrach, , Baden-Württemberg, Germany
- Department of Orthopaedics and Trauma Surgery, University Hospital of Assiut, Assiut, Egypt
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Yu KE, Marigi EM, Austin DC, Tangtiphaiboontana J, Esper R, Barlow JD, Morrey ME, Sanchez-Sotelo J. Operative treatment of acromial and scapular spine fracture nonunions complicating reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2024:S1058-2746(24)00465-8. [PMID: 38992415 DOI: 10.1016/j.jse.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Fractures of the acromion and spine can have a major impact on the outcome of reverse shoulder arthroplasty (RSA) with respect to pain, motion, and function. Reports on internal fixation for these fractures are isolated to small series or case reports with variable outcomes. The purpose of this study was to report on the outcome of open reduction and internal fixation (ORIF) of acromion or spine fractures encountered before or after RSA and describes our evolution of fixation techniques. METHODS Between 2011 and 2023, 22 fractures or nonunions of the acromion or spine of the scapula underwent ORIF at a single institution and were followed for a minimum of 1 year. In 16 shoulders, fractures occurred after RSA, whereas 5 shoulders underwent ORIF prior to RSA. One shoulder had undergone prior failed ORIF elsewhere and revision ORIF was performed at our institution. There were 10 males and 12 females with a mean age of 67 (SD = 15.1) years. Fixation strategies included single (n = 11) and double plate fixation (n = 11). Kruskal-Wallis one-way analyses of variance were used to analyze continuous variables and Chi-square tests employed for categorical variables. RESULTS Of the 5 fractures treated with ORIF pre-RSA, 1 shoulder suffered an additional fracture medial to the hardware and 1 required additional bone grafting for incomplete union at the time of RSA. These 5 shoulders all underwent RSA uneventfully, but 1 fracture experienced late displacement of the scapular spine nonunion, leading to plate removal. Of the 16 post-RSA ORIF shoulders, radiographic union was confirmed in 14 and substantial residual inferior angulation identified in 3. New fractures occurred after ORIF in 5 shoulders. For patients who underwent ORIF after RSA, pain scores improved from a mean of 8 to 1.9 points, with more modest elevation gains (58.2°-91.3° pre and postoperatively, respectively). CONCLUSIONS ORIF of acromion and scapular spine fractures or nonunions in the setting of RSA have the potential to lead to union. When these fractures and nonunions are encountered prior to RSA, ORIF allows for uneventful RSA implantation, but secondary displacement may occur. ORIF seems to lead to improvements in pain, but more modest improvements in motion and function. Our fixation strategy has evolved to (1) dual plating, (2) spanning the whole length of the spine with 1 of the plates, (3) use of hook features under the acromion or os trigonum if possible, and (4) liberal use of bone graft.
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Affiliation(s)
- Kristin E Yu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Ronda Esper
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Kazemi N. Acromial stress fracture after anatomic shoulder arthroplasty: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:266-271. [PMID: 38706669 PMCID: PMC11065731 DOI: 10.1016/j.xrrt.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Namdar Kazemi
- Washington Orthopaedic Center, Centralia, WA, USA
- Christ Hospital Physicians, Joint and Spine, Cincinnati, OH, USA
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Pastor MF, Nebel D, Degering A, Smith T, Karkosch R, Horstmann H, Ellwein A. Biomechanical comparison of single versus double plate osteosynthesis in acromion type III fractures. Orthop Rev (Pavia) 2024; 16:88396. [PMID: 38765296 PMCID: PMC10770366 DOI: 10.52965/001c.88396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Background One of complications of the reverse shoulder arthroplasty is acromion fractures, and its therapy is controversial. The aim of the study was to investigate the double-plate osteosynthesis for these fractures. Methods An acromion type III fracture according to classification of Levy was simulated in 16 human shoulder cadavers, and the specimens were randomly divided into two groups. Single-plate osteosynthesis was performed in the first group (locking compression plate) and double-plate osteosynthesis (locking compression plate and one-third tubular locking plate) in the second group. Biomechanical testing included cycling load and load at failure on a material testing machine. During the test, the translation was measured using an optical tracking system. Results The load at failure for the single-plate osteosynthesis was 167 N and for the double-osteosynthesis 233.7 N (P = 0.328). The average translation was 11.1 mm for the single-plate osteosynthesis and 16.4 mm for the double-plate osteosynthesis (P = 0.753). The resulting stiffness resulted in 74.7 N/mm for the single-plate osteosynthesis and 327.9 N/mm for the double-plate osteosynthesis (P = 0.141). Discussion Results of the biomechanical study showed that double-plate osteosynthesis had biomechanical properties similar to those of single-plate osteosynthesis for an acromion type III fracture at time point zero. The missing advantages of double-plate osteosynthesis can be explained by the choice of plate configuration.
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Andrews R, Layuno-Matos JG, Frankle MA. Common Factors in Shoulder and Hip Arthroplasty Implant Failures: A Historical Review. J Clin Med 2024; 13:2370. [PMID: 38673642 PMCID: PMC11051213 DOI: 10.3390/jcm13082370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/30/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
In this era of subspecialty care in orthopedics, iterations of implant design can occur in a silo which then precludes gaining knowledge from failures of implant design that may have occurred in different subspecialties. This literature review describes the history of failures in hip and shoulder arthroplasties with the purpose of identifying similar factors that led to previous implant failures. A review of the literature was performed by two reviewers assessing articles that described failed hip and shoulder arthroplasty systems over time. We identified and analyzed 53 implant failures-23 in hip arthroplasty and 30 in shoulder arthroplasty. These failures were categorized as material, mechanical, and technical. In hip arthroplasty, 48% were material, 39% mechanical, and 13% technical failures. In shoulder arthroplasty, the distribution was 10% material, 70% mechanical, and 20% technical failures. The distribution of these failures highlights similar and sometimes repeated failure mechanisms between subspecialties. This accentuates the importance of a collaborative approach to improve future arthroplasty designs.
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Affiliation(s)
- Reed Andrews
- Department of Orthopaedics, School of Medicine, University of South Florida, Tampa, FL 33612, USA;
| | | | - Mark A. Frankle
- Foundation for Orthopaedic Research and Education, Tampa, FL 33607, USA;
- Florida Orthopaedic Institute, Tampa, FL 33637, USA
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Haase L, Ina J, Harlow E, Chen R, Gillespie R, Calcei J. The Influence of Component Design and Positioning on Soft-Tissue Tensioning and Complications in Reverse Total Shoulder Arthroplasty: A Review. JBJS Rev 2024; 12:01874474-202404000-00002. [PMID: 38574183 DOI: 10.2106/jbjs.rvw.23.00238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
» Reverse total shoulder arthroplasty was designed to function in the rotator cuff deficient shoulder by adjusting the glenohumeral center of rotation (COR) to maximize deltoid function.» Adjustments in the COR ultimately lead to changes in resting tension of the deltoid and remaining rotator cuff, which can affect implant stability and risk of stress fracture.» Soft-tissue balance and complication profiles can be affected by humeral component (version, neck shaft angle, and inlay vs. onlay) and glenoid component (sagittal placement, version, inclination, and lateralization) design and application.» A good understanding of the effects on soft-tissue balance and complication profile is critical for surgeons to best provide optimal patient outcomes.
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Affiliation(s)
- Lucas Haase
- University Hospitals of Cleveland, Cleveland, Ohio
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Park JH, Kim HG, Kim JS, Kim SC, Yoo JC. SPECT/CT for Early Detection of Stress Reactions After Reverse Shoulder Arthroplasty: Potential Clinical Significance. Clin Nucl Med 2024; 49:246-249. [PMID: 38271252 DOI: 10.1097/rlu.0000000000005019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT The altered biomechanics after reverse shoulder arthroplasty, combined with the accumulation of various stress risers, can lead to stress fractures (SFs) around the prosthesis. The incidence of stress reactions (SRs) after reverse shoulder arthroplasty, characterized by pain and tenderness without radiographic or CT evidence of fractures, is approximately 4.2%, which is comparable to the incidence of SF (6.4%). Among patients with SR, a substantial 32% eventually progress to fractures during clinical follow-up. SPECT/CT is a promising tool that combines morphologic and metabolic information for assessing mechanical bone stress. Therefore, early detection of SR through SPECT/CT can help prevent SF.
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Affiliation(s)
- Jong Hun Park
- From the Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
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Sherman N, Hill B, Nisbet B, Knox A, Mahoney A. Bilateral atraumatic acromial base fractures following reverse shoulder arthroplasty managed with open reduction and internal fixation: a case report. JSES Int 2024; 8:95-98. [PMID: 38312292 PMCID: PMC10837714 DOI: 10.1016/j.jseint.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Affiliation(s)
- Nathan Sherman
- Department of Orthopedic Surgery, University of Arizona, Tucson, AZ, USA
| | - Brogan Hill
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV, USA
| | - Bryn Nisbet
- Department of Orthopedic Surgery, University of Arizona, Tucson, AZ, USA
| | - Andrew Knox
- Tucson Orthopaedic Institute, Tucson, AZ, USA
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Lohre R, Swanson DP, Mahendraraj KA, Elmallah R, Glass EA, Dunn WR, Cannon DJ, Friedman LG, Gaudette JA, Green J, Grobaty L, Gutman M, Kakalecik J, Kloby MA, Konrade EN, Knack MC, Loveland A, Mathew JI, Myhre L, Nyfeler J, Parsell DE, Pazik M, Polisetty TS, Ponnuru P, Smith KM, Sprengel KA, Thakar O, Turnbull L, Vaughan A, Wheelwright JC, Abboud J, Armstrong A, Austin L, Brolin T, Entezari V, Garrigues GE, Grawe B, Gulotta LV, Hobgood R, Horneff JG, Iannotti J, Khazzam M, King JJ, Kirsch JM, Levy JC, Murthi A, Namdari S, Nicholson GP, Otto RJ, Ricchetti ET, Tashjian R, Throckmorton T, Wright T, Jawa A. Risk factors of acromial and scapular spine stress fractures differ by indication: a study by the ASES Complications of Reverse Shoulder Arthroplasty Multicenter Research Group. J Shoulder Elbow Surg 2023; 32:2483-2492. [PMID: 37330167 DOI: 10.1016/j.jse.2023.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/20/2023] [Accepted: 05/06/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Both patient and implant related variables have been implicated in the incidence of acromial (ASF) and scapular spine fractures (SSF) following reverse shoulder arthroplasty (RSA); however, previous studies have not characterized nor differentiated risk profiles for varying indications including primary glenohumeral arthritis with intact rotator cuff (GHOA), rotator cuff arthropathy (CTA), and massive irreparable rotator cuff tear (MCT). The purpose of this study was to determine patient factors predictive of cumulative ASF/SSF risk for varying preoperative diagnosis and rotator cuff status. METHODS Patients consecutively receiving RSA between January 2013 and June 2019 from 15 institutions comprising 24 members of the American Shoulder and Elbow Surgeons (ASES) with primary, preoperative diagnoses of GHOA, CTA and MCT were included for study. Inclusion criteria, definitions, and inclusion of patient factors in a multivariate model to predict cumulative risk of ASF/SSF were determined through an iterative Delphi process. The CTA and MCT groups were combined for analysis. Consensus was defined as greater than 75% agreement amongst contributors. Only ASF/SSF confirmed by clinical and radiographic correlation were included for analysis. RESULTS Our study cohort included 4764 patients with preoperative diagnoses of GHOA, CTA, or MCT with minimum follow-up of 3 months (range: 3-84). The incidence of cumulative stress fracture was 4.1% (n = 196). The incidence of stress fracture in the GHOA cohort was 2.1% (n = 34/1637) compared to 5.2% (n = 162/3127) (P < .001) in the CTA/MCT cohort. Presence of inflammatory arthritis (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.08-7.78; P = .035) was the sole predictive factor of stress fractures in GHOA, compared with inflammatory arthritis (OR 1.86, 95% CI 1.19-2.89; P = .016), female sex (OR 1.81, 95% CI 1.20-2.72; P = .007), and osteoporosis (OR 1.56, 95% CI 1.02-2.37; P = .003) in the CTA/MCT cohort. CONCLUSION Preoperative diagnosis of GHOA has a different risk profile for developing stress fractures after RSA than patients with CTA/MCT. Though rotator cuff integrity is likely protective against ASF/SSF, approximately 1/46 patients receiving RSA with primary GHOA will have this complication, primarily influenced by a history of inflammatory arthritis. Understanding risk profiles of patients undergoing RSA by varying diagnosis is important in counseling, expectation management, and treatment by surgeons.
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Affiliation(s)
- Ryan Lohre
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston Shoulder Institute, Boston, MA, USA
| | - Daniel P Swanson
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Kuhan A Mahendraraj
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Randa Elmallah
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Evan A Glass
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Warren R Dunn
- Fondren Orthopaedic Group, Orthopaedic Surgery, Houston, TX, USA
| | - Dylan J Cannon
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | - Lisa Gm Friedman
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Jaina A Gaudette
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - John Green
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Lauren Grobaty
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jaquelyn Kakalecik
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael A Kloby
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elliot N Konrade
- University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, Memphis, TN, USA
| | - Margaret C Knack
- University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, Memphis, TN, USA
| | - Amy Loveland
- MedStar Union Memorial Hospital, Baltimore, MD, USA
| | | | - Luke Myhre
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jacob Nyfeler
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Doug E Parsell
- Mississippi Sports Medicine and Orthopaedic Surgery, Jackson, MS, USA
| | - Marissa Pazik
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | | | | | - Karch M Smith
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Ocean Thakar
- MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lacie Turnbull
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | | | | | - Joseph Abboud
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | | | - Luke Austin
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Tyler Brolin
- University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, Memphis, TN, USA
| | - Vahid Entezari
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Grawe
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Rhett Hobgood
- Mississippi Sports Medicine and Orthopaedic Surgery, Jackson, MS, USA
| | | | - Joseph Iannotti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jacob M Kirsch
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Jonathan C Levy
- Levy Shoulder Center at Paley Orthopedic and Spine Institute, Boca Raton, FL, USA
| | - Anand Murthi
- MedStar Union Memorial Hospital, Baltimore, MD, USA
| | | | - Gregory P Nicholson
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Randall J Otto
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Tashjian
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Thomas Throckmorton
- University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, Memphis, TN, USA
| | - Thomas Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA.
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Haeffner BD, Cueto RJ, Abdelmalik BM, Hones KM, Wright JO, Srinivasan RC, King JJ, Wright TW, Werthel JD, Schoch BS, Hao KA. The association between humeral lengthening and clinical outcomes after reverse shoulder arthroplasty: a systematic review and meta-analysis. J Shoulder Elbow Surg 2023; 32:e477-e494. [PMID: 37379967 DOI: 10.1016/j.jse.2023.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/04/2023] [Accepted: 05/13/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the relationship between humeral lengthening and clinical outcomes after reverse shoulder arthroplasty (RSA) with stratification based on measurement method and implant design. METHODS This systematic review was performed using PRISMA-P guidelines. PubMed/Medline, Cochrane Trials, and Embase were queried for articles evaluating the relationship between humeral lengthening and clinical outcomes inclusive of range of motion (ROM), strength, outcome scores, and pertinent complications (acromial and scapular spine fractures, nerve injury) after RSA. The relationship between humeral lengthening and clinical outcomes was reported descriptively overall and stratified by measurement method and implant design (globally medialized vs. lateralized). A positive association was defined as increased humeral lengthening being associated with greater ROM, outcome scores, or a greater incidence of complications, whereas a negative association denoted that increased humeral lengthening was associated with poorer ROM, outcome scores, or a lower incidence of complications. Meta-analysis was performed to compare humeral lengthening between patients with and without fractures of the acromion or scapular spine. RESULTS Twenty-two studies were included. Humeral lengthening was assessed as the acromiohumeral distance (AHD), the distance from the acromion to the greater tuberosity (AGT), the acromion to the deltoid tuberosity (ADT), and the acromion to the distal humerus (ADH). Of 11 studies that assessed forward elevation, a positive association with humeral lengthening was found in 6, a negative association was found in 1, and 4 studies reported no association. Of studies assessing internal rotation (n = 9), external rotation (n = 7), and abduction (n = 4), all either identified a positive or lack of association with humeral lengthening. Studies assessing outcome scores (n = 11) found either a positive (n = 5) or no (n = 6) association with humeral lengthening. Of the studies that assessed fractures of the acromion and/or scapular spine (n = 6), 2 identified a positive association with humeral lengthening, 1 identified a negative association, and 3 identified no association. The single study that assessed the incidence of nerve injury identified a positive association with humeral lengthening. Meta-analysis was possible for AGT (n = 2) and AHD (n = 2); greater humeral lengthening was found in patients with fractures for studies using the AGT (mean difference 4.5 mm, 95% CI 0.7-8.3) but not the AHD. Limited study inclusion and heterogeneity prohibited identification of trends based on method of measuring humeral lengthening and implant design. CONCLUSION The relationship between humeral lengthening and clinical outcomes after RSA remains unclear and requires future investigation using a standardized assessment method.
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Affiliation(s)
- Brett D Haeffner
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Robert J Cueto
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Keegan M Hones
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | | | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | | | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
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Chen J, Chen C, Nour M, Liu D, Zhu Y, Zhang W, Polat K, Deng X. Morphology properties of scapular spine relative to reverse shoulder arthroplasty: A biomechanical study. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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12
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Walker JK, Richards BW, Cronin JT, Skedros JG. Octogenarian With Acromion Stress Fracture Nonunion With Reverse Total Shoulder Prosthesis Reconstructed With Plates and Screws: A Case Report. Cureus 2023; 15:e42865. [PMID: 37664248 PMCID: PMC10473861 DOI: 10.7759/cureus.42865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/05/2023] Open
Abstract
An 85-year-old male underwent open reduction and internal fixation (ORIF) for a displaced acromion stress fracture that occurred two years prior. The complete fracture occurred two months after an ipsilateral reverse total shoulder arthroplasty (RTSA). Four weeks after his RTSA, the pain was felt at the posterior-superior shoulder with activities of his daily living as a rancher, reflecting non-compliant use. A stress fracture was suspected but not detected radiographically. Four weeks later, higher pain occurred after he lifted a hay bale, and a displaced basilar acromion fracture was detected. Non-operative management spanned 20 months, which he ultimately deemed unacceptable because of pain with minor activities. ORIF was then done. Approximately 10 months after the ORIF surgery, both plates sustained fatigue breakage; however, the fracture consolidated, and his pain remained low. He is the oldest patient described to ultimately have a successful acromion fracture ORIF and only the third reported acromion fracture ORIF in octogenarians following RTSA. We report the ORIF technique, its good outcome, and a literature review of elderly patients who had ORIF for this problem.
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Affiliation(s)
- Jamison K Walker
- School of Medicine, Campbell University School of Osteopathic Medicine, Buies Creek, USA
| | - Brett W Richards
- Shoulder & Elbow, Utah Orthopaedic Specialists, Salt Lake City, USA
| | - John T Cronin
- Shoulder & Elbow, Utah Orthopaedic Specialists, Salt Lake City, USA
| | - John G Skedros
- Shoulder & Elbow, Utah Orthopaedic Specialists, Salt Lake City, USA
- Orthopaedics, University of Utah, Salt Lake City, USA
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13
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White AE, Brusalis CM, Wellman DS, Taylor SA. Botulinum toxin as adjunct therapy in surgical management of a periprosthetic scapular spine fracture: a case report. Clin Shoulder Elb 2023; 26:87-92. [PMID: 35791683 PMCID: PMC10030983 DOI: 10.5397/cise.2021.00556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Six months after undergoing reverse shoulder arthroplasty (RSA) a 73-year-old woman sustained a periprosthetic scapular spine fracture following a fall. She was treated with open reduction and internal fixation (ORIF), followed by botulinum toxin injection into the deltoid muscle to temporarily minimize strain at the fracture. Fracture union was achieved by 3 months, with excellent clinical function more than 1 year following fracture fixation and full resolution of deltoid function. Scapular spine fracture following RSA can be treated with ORIF and temporary deltoid paralysis using botulinum toxin in the immediate postoperative period to safely support fracture healing.
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Affiliation(s)
- Alex E White
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - David S Wellman
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Samuel A Taylor
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA
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14
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Galán-Olleros M, Lopiz Y, Ciller G, Alcobía-Díaz B, García-Fernández C, Marco F. Does fluoroscopy improve baseplate position compared to conventional technique in reverse shoulder arthroplasty? A preliminary study. Shoulder Elbow 2023; 15:15-26. [PMID: 36895612 PMCID: PMC9990097 DOI: 10.1177/17585732211020657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/15/2022]
Abstract
Background Accurate placement of glenoid component in reverse shoulder arthroplasty remains a challenge for surgeons of all levels of expertise; however, no studies have evaluated the utility of fluoroscopy as a surgical assistance method. Methods Prospective comparative study of 33 patients undergoing primary reverse shoulder arthroplasty during a 12-month period. Fifteen patients had a baseplate placed using the conventional "free hand" technique (control group), and 18 patients using intraoperative fluoroscopy assistance group, in a case-control design. Postoperative glenoid position was evaluated on postoperative Computed Tomography (CT) scan. Results The mean deviation of version and inclination for fluoroscopy assistance vs. control group was 1.75° (0.675-3.125) vs. 4.2° (1.975-10.45) (p = .015), and 3.85° (0-7.225) vs. 10.35° (4.35-18.75) (p = .009). The distance from the central peg midpoint to the inferior glenoid rim (fluoroscopy assistance 14.61 mm/control 4.75 mm, p = .581) and the surgical time (fluoroscopy assistance 1.93 ± 0.57/control 2.18 ± 0.44 h, p = .400) showed no differences, with an average radiation dose of 0.45 mGy and fluoroscopy time of 14 s. Conclusions Accurate axial and coronal scapular plane positioning of glenoid component is improved with intraoperative fluoroscopy at the cost of a greater radiation dose and without differences in surgical time. Comparative studies are needed to determine whether their use in relation to more expensive surgical assistance systems result in similar effectiveness.L evel of evidence : Level III, therapeutic study.
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Affiliation(s)
- María Galán-Olleros
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
| | - Yaiza Lopiz
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
- Department of Surgery, Complutense
University, Madrid, Spain
| | - Gabriel Ciller
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
| | - Borja Alcobía-Díaz
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
- Department of Surgery, Complutense
University, Madrid, Spain
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15
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Schenk P, Aichmair A, Beeler S, Jentzsch T, Gerber C. Clinical results of conservative versus operative treatment of acromial and scapular spine fractures following reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:2076-2081. [PMID: 35447315 DOI: 10.1016/j.jse.2022.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acromial and scapular spine fractures are common complications after reverse total shoulder arthroplasty (RTSA). There is limited information on the treatment outcome of these fractures. Therefore, the purpose of this study was to compare the clinical outcome of operative and conservative treatment of patients with acromial or scapular spine fractures. METHODS A total of 1146 RTSAs were performed in our institution between 1999 and 2016. In 23 patients (2%), we identified an acromial fracture, and in 7 cases (0.6%), a scapular spine fracture in the postoperative course. Of those patients, 7 patients (23%) were treated with open reduction and internal fixation and 23 (77%) were treated conservatively. We compared the outcome of operative vs. conservative treatment assessing the Constant score (CS), range of motion, and subjective shoulder value (SSV). Fractures were classified by the system of Crosby. Radiographic assessment consisted of measuring the healing rate, time to heal, and the displacement of the acromion before and immediately after the fracture as well as after treatment. RESULTS There were no statistically significant differences between operative and conservative treatment. The mean preoperative CS in the operative group was 32 points and improved to 45 points after surgery, whereas it was 35 points in the conservative group and improved to 61 points at the final follow-up. The mean SSV improved from 20 to 50 points in the operative group and from 22 to 58 points in the conservative group. Mean active flexion changed from 59° to 75°, mean abduction from 68° to 67°, and external rotation from 25° to 13° in the operative group and from 75° to 91°, 67° to 92°, and 28° to 24° in the conservative group. CONCLUSIONS In our study, operative treatment was not superior to conservative treatment, neither for CS, SSV, or range of motion. Both treatment forms, however, resulted in inferior results to those previously reported for RTSA without postoperative acromion fractures. Before better surgical methods have been developed, conservative treatment of acromial fractures may be the better treatment option for acromial fractures after RTSA.
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Affiliation(s)
- Pascal Schenk
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| | - Alexander Aichmair
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Silvan Beeler
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Thorsten Jentzsch
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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16
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Haidamous G, Merimee S, Simon P, Denard PJ, Lädermann A, Mighell MA, Gorman RA, Frankle MA. Acromial fractures following reverse shoulder arthroplasty: the role of the acromial morphology and a comparison of clinical outcomes. J Shoulder Elbow Surg 2022; 31:S34-S43. [PMID: 35183742 DOI: 10.1016/j.jse.2022.01.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/10/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose was to evaluate the relationship between acromial morphology and the location of acromial fractures following reverse shoulder arthroplasty and determine whether fracture location and displacement impact clinical outcomes. METHODS We performed a multicenter retrospective review of reverse shoulder arthroplasties complicated by acromial fractures. Radiographs were compared to determine the differences in acromial morphology, as well as fracture orientation and pattern, between patients with Levy type I (n = 17) and Levy type II (n = 25) fractures. Patients with a minimum of 2 years' follow-up were selected to examine the association between clinical outcomes and fracture location and displacement. Twenty-two patients were stratified based on whether they achieved the minimal clinically important difference (MCID) in the American Shoulder and Elbow Surgeons score (20 points). The groups were then compared regarding fracture location and displacement using measurements such as the acromiohumeral distance. RESULTS The Levy type I group had a higher acromial slope than the Levy type II group (127° vs. 117°, P < .001). Levy type I fractures had a transverse pattern occurring in the coronal plane, whereas Levy type II fractures had an oblique pattern occurring in the sagittal plane (P < .001). At final follow-up, 12 of 22 patients (55%) achieved the MCID. Those who did not achieve the MCID had more displaced fractures including a lower acromiohumeral distance (8 mm vs. 20 mm, P = .007). There was no difference in the distribution of Levy type I and type II fractures based on the MCID cutoff (P = .093). CONCLUSION An increased acromial slope is associated with transverse fractures in the Levy I region, whereas a lower acromial slope is associated with oblique fractures in the Levy II region. Overall, 55% of patients achieved the MCID at mid-term follow-up. The outcomes of those who did not achieve the MCID became worse postoperatively, and this was associated with increased fracture displacement.
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Affiliation(s)
| | - Stephanie Merimee
- Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Peter Simon
- Translational Research, Foundation for Orthopaedic Research and Education (FORE), Tampa, FL, USA; Department of Medical Engineering, University of South Florida College of Engineering and Morsani College of Medicine, Tampa, FL, USA
| | - Patrick J Denard
- Southern Oregon Orthopedics, Oregon Shoulder Institute, Medford, OR, USA
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Mark A Mighell
- Shoulder Service, Florida Orthopaedic Institute, Tampa, FL, USA
| | - R Allen Gorman
- Translational Research, Foundation for Orthopaedic Research and Education (FORE), Tampa, FL, USA
| | - Mark A Frankle
- Shoulder Service, Florida Orthopaedic Institute, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
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17
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Incidence, radiographic predictors, and clinical outcome of acromial stress reaction and acromial fractures in reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 31:1143-1153. [PMID: 34968697 DOI: 10.1016/j.jse.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acromial and scapular spine fractures (ASFs) are known complications following implantation of reverse total shoulder arthroplasty (RTSA). The entity of acromial stress reaction (ASR) without fracture has recently been described. The purpose of this study was to analyze the incidence, radiographic predictors, treatment options, healing rates, and clinical outcomes of ASF and ASR compared with a control group. METHODS A total of 854 primary RTSAs were implanted between 2005 and 2018 in a single shoulder unit of a tertiary referral hospital and retrospectively reviewed for the incidence of ASF and ASR. ASR was defined as pain at the acromion or scapular spine after fracture exclusion on computed tomography scans. The ASF group was matched to a control group. Preoperative and postoperative radiographs were analyzed for radiographic predictors of ASF or ASR. The impact of ASF and ASR, operative vs. nonoperative treatment, and fracture union on clinical outcomes (Constant-Murley score [CS], Subjective Shoulder Value [SSV], and range of motion) with a minimum follow-up period of 2 years was analyzed. RESULTS A total of 46 ASFs (5.4%) in 44 patients and 44 ASRs (5.2%) in 43 patients were detected at a mean of 16 ± 24 months and 20 ± 23 months postoperatively, respectively. Predictive radiographic factors were an increased critical shoulder angle and lateralization shoulder angle. The overall union rate was 55% (22 of 40) but was significantly higher following operative treatment (9 of 11, 82%) compared with nonoperative treatment (13 of 29, 45%). Patients with ASF or ASR demonstrated inferior clinical outcomes (CS, 44 ± 21 and 48 ± 18; SSV, 52% ± 25% and 57% ± 27%) compared with the control group (CS, 66 ± 14; SSV, 82% ± 22%) independent of bony union or treatment at a mean of 59 ± 33 months (ASF) and 61 ± 38 months (ASR). CONCLUSION ASF and ASR are frequent complications following RTSA implantation with similar poor clinical outcome measures. The healing rate was shown to be much higher with a surgical approach. Nevertheless, fracture consolidation does not result in better clinical outcomes compared with nonunion.
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18
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Hollensteiner M, Sandriesser S, Rittenschober F, Hochreiter J, Augat P, Ernstbrunner L, Ortmaier R. Single or Double Plating for Acromial Type III Fractures: Biomechanical Comparison of Load to Failure and Fragment Motion. J Clin Med 2022; 11:3130. [PMID: 35683515 PMCID: PMC9181566 DOI: 10.3390/jcm11113130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Acromial Levy III fractures after inverse shoulder arthroplasty occur in up to 7% of patients. To date, it is not clear how these fractures should be treated as clinical outcomes remain unsatisfactory. The aim of this study was to evaluate the biomechanical performance of three different plating methods of type III acromion fractures. METHODS Levy III fractures in synthetic scapulae were fixed with three different methods. Angular stable locking plates were placed on the spina scapula to bridge the fracture either dorsally, caudally, or on both aspects by double plating. In a biomechanical experiment, the pull of the deltoid muscle at 40° abduction of the arm was simulated by cyclic loading with increasing load levels until failure. Failure load, cycles to failure, and fragment motions were evaluated. RESULTS The results showed that double plating (350 ± 63 N) withstood the highest loads until failure, followed by dorsal (292 ± 20 N) and caudal (217 ± 49 N) plating. Similarly, double plating showed significantly smaller fragment movement than the other two groups. CONCLUSIONS Double plating appeared to provide the largest biomechanical stability in type III acromion fracture under arm abduction. Caudal plating in contract resulted in insufficient fracture stability and early failure and can thus not be recommended from a biomechanical point of view.
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Affiliation(s)
- Marianne Hollensteiner
- Institute for Biomechanics, BG Unfallklinik Murnau gGmbH, 82418 Murnau, Germany; (M.H.); (S.S.); (P.A.)
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Sabrina Sandriesser
- Institute for Biomechanics, BG Unfallklinik Murnau gGmbH, 82418 Murnau, Germany; (M.H.); (S.S.); (P.A.)
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Felix Rittenschober
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 4020 Linz, Austria; (F.R.); (J.H.)
| | - Josef Hochreiter
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 4020 Linz, Austria; (F.R.); (J.H.)
| | - Peter Augat
- Institute for Biomechanics, BG Unfallklinik Murnau gGmbH, 82418 Murnau, Germany; (M.H.); (S.S.); (P.A.)
- Institute for Biomechanics, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC 3052, Australia;
- Melbourne Orthopaedic Group, Windsor, VIC 3181, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia
| | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 4020 Linz, Austria; (F.R.); (J.H.)
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19
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Bartolotta RJ, Ha AS. Current Imaging Concepts in Shoulder and Hip Arthroplasty. Radiol Clin North Am 2022; 60:669-678. [DOI: 10.1016/j.rcl.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Yeazell ST, Inacio J, Malige A, Dailey H, Carolan GF. Bone density and its relation to the development of acromial stress fracture following reverse total shoulder arthroplasty. Shoulder Elbow 2022; 14:135-141. [PMID: 35265178 PMCID: PMC8899318 DOI: 10.1177/1758573220949992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/14/2020] [Accepted: 07/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative acromial stress fracture is a troublesome postoperative complication after reverse shoulder arthroplasty. Our study aims to utilize routinely performed preoperative computed tomography scans to identify differences in the material properties of the acromion in patients who did and did not develop a postoperative acromial stress fracture. METHODS Treatment records and computed tomography scans for 99 reverse shoulder arthroplasties were collected. Scans were calibrated using a phantom and transferred for post-processing where the acromion, full scapula, and humeral head were isolated. The final segmented model was used to assess acromial volume and volumetric bone mineral density for each region of interest. RESULTS There was no association between age and volumetric bone mineral density in any region of interest (all R 2 ≤ 0.048, all p > 0.082). Patients who developed an acromial stress fracture were not significantly different from those who did not in terms of age, acromial volume, or acromial volumetric bone mineral density (all p > 0.559). Patients with known osteoporosis or osteopenia had slightly lower volumetric bone mineral density, but the differences were not significant (all p ≥ 0.072). CONCLUSION Postoperative acromial fractures following reverse shoulder arthroplasty cannot be predicted by computed tomography-derived volumetric bone mineral density or volume. These mechanical characteristics also do not predictably decrease with age or osteoporosis diagnosis.
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Affiliation(s)
- Shawn T Yeazell
- Department of Orthopedic Surgery, St Luke's University Health Network, Bethlehem, USA,Shawn T Yeazell, Department of Orthopedic Surgery, St Luke's University Health Network, 801 Ostrum St. PPHP2, Bethlehem, PA 18015, USA.
| | - Jordan Inacio
- Department of Mechanical Engineering and Mechanics, Lehigh University Packard Laboratory, Bethlehem, USA
| | - Ajith Malige
- Department of Orthopedic Surgery, St Luke's University Health Network, Bethlehem, USA
| | - Hannah Dailey
- Department of Mechanical Engineering and Mechanics, Lehigh University Packard Laboratory, Bethlehem, USA
| | - Gregory F Carolan
- Department of Orthopedic Surgery, St Luke's University Health Network, Bethlehem, USA
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21
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Scapular Fractures After Reverse Shoulder Arthroplasty. J Am Acad Orthop Surg 2022; 30:e517-e527. [PMID: 35050935 DOI: 10.5435/jaaos-d-20-01205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 11/13/2021] [Indexed: 02/01/2023] Open
Abstract
With the increased use of reverse shoulder arthroplasty, the complication of postoperative scapular fracture is increasingly recognized. The incidence is variable and dependent on a combination of factors including patient age, sex, bone mineral density, diagnosis of inflammatory arthritis, acromial thickness, and implant-related factors. Acromial stress reactions are a clinical diagnosis based on a history and physical examination. These are treated successfully with 4 to 6 weeks of immobilization. Acromial stress fractures are visible on imaging studies and are classified based on anatomic location by the classification systems of Crosby and Levy. In approximately 20% of fractures, a CT scan is necessary to make the diagnosis. Treatment is typically nonsurgical that leads to a high rate of nonunion or symptomatic malunion. Scapular spine fractures (type III) can be treated with either nonsurgical or surgical management; however, obtaining fracture union is challenging, and the outcomes are typically inferior to that of type I and II fractures. Although the nonsurgical and surgical treatment of acromial stress fractures improves the clinical outcomes from the patient's preoperative state, the outcomes of a control group undergoing reverse shoulder arthroplasty without fracture are better. The exception to this is oftentimes the displaced and angulated type III fracture.
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22
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Paszicsnyek A, Jo O, Rupasinghe HS, Ackland DC, Treseder T, Pullen C, Hoy G, Ek ET, Ernstbrunner L. Factors Influencing Acromial and Scapular Spine Strain after Reverse Total Shoulder Arthroplasty: A Systematic Review of Biomechanical Studies. J Clin Med 2022; 11:361. [PMID: 35054057 PMCID: PMC8778957 DOI: 10.3390/jcm11020361] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/30/2021] [Accepted: 01/07/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) can be devastating complications leading to substantial functional impairments. The purpose of this study was to review factors associated with increased acromial and scapular spine strain after RTSA from a biomechanical standpoint. METHODS A systematic review of the literature was conducted based on PRISMA guidelines. PubMed, Embase, OVID Medline, and CENTRAL databases were searched and strict inclusion and exclusion criteria were applied. Each article was assessed using the modified Downs and Black checklist to appraise the quality of included studies. Study selection, extraction of data, and assessment of methodological quality were carried out independently by two of the authors. Only biomechanical studies were considered. RESULTS Six biomechanical studies evaluated factors associated with increased acromial and scapular spine strain and stress. Significant increases in acromial and scapular spine strain were found with increasing lateralization of the glenosphere in four of the included studies. In two studies, glenosphere inferiorization consistently reduced acromial strain. The results concerning humeral lateralization were variable between four studies. Humeral component neck-shaft angle had no significant effect on acromial strain as analysed in one study. One study showed that scapular spine strain was significantly increased with a more posteriorly oriented acromion (55° vs. 43°; p < 0.001). Another study showed that the transection of the coracoacromial ligament increased scapular spine strain in all abduction angles (p < 0.05). CONCLUSIONS Glenoid lateralization was consistently associated with increased acromial and scapular spine strain, whereas inferiorization of the glenosphere reduced strain in the biomechanical studies analysed in this systematic review. Humeral-sided lateralization may increase or decrease acromial or scapular spine strain. Independent of different design parameters, the transection of the coracoacromial ligament resulted in significantly increased strains and scapular spine strains were also increased when the acromion was more posteriorly oriented. The results found in this systematic review of biomechanical in-silico and in-vitro studies may help in the surgical planning of RTSA to mitigate complications associated with acromion and scapular spine fracture.
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Affiliation(s)
- Alexander Paszicsnyek
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria;
| | - Olivia Jo
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (T.T.); (C.P.)
| | - Harshi Sandeepa Rupasinghe
- Department of Biomedical Engineering, University of Melbourne, Parkville, Melbourne, VIC 3010, Australia; (H.S.R.); (D.C.A.)
| | - David C. Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Melbourne, VIC 3010, Australia; (H.S.R.); (D.C.A.)
| | - Thomas Treseder
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (T.T.); (C.P.)
| | - Christopher Pullen
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (T.T.); (C.P.)
| | - Greg Hoy
- Melbourne Orthopaedic Group, Windsor, VIC 3181, Australia; (G.H.); (E.T.E.)
| | - Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, VIC 3181, Australia; (G.H.); (E.T.E.)
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC 3050, Australia; (O.J.); (T.T.); (C.P.)
- Department of Biomedical Engineering, University of Melbourne, Parkville, Melbourne, VIC 3010, Australia; (H.S.R.); (D.C.A.)
- Melbourne Orthopaedic Group, Windsor, VIC 3181, Australia; (G.H.); (E.T.E.)
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23
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Razmjou H, van Osnabrugge V, Anunciacion M, Nunn A, Drosdowech D, Roszkowski A, Szafirowicz A, Boljanovic D, Wainwright A, Nam D. Maximizing Muscle Function in Cuff-Deficient Shoulders: A Rehabilitation Proposal for Reverse Arthroplasty. J Shoulder Elb Arthroplast 2022; 5:24715492211023302. [PMID: 34993379 PMCID: PMC8492033 DOI: 10.1177/24715492211023302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/17/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose The purpose of this review is to describe the role of altered joint biomechanics in reverse shoulder arthroplasty and to propose a rehabilitation protocol for a cuff-deficient glenohumeral joint based on the current evidence.Methods and Materials: The proposed rehabilitation incorporates the principles of pertinent muscle loading while considering risk factors and surgical complications. Results In light of altered function of shoulder muscles in reverse arthroplasty, scapular plane abduction should be more often utilized as it better activates deltoid, teres minor, upper trapezius, and serratus anterior. Given the absence of supraspinatus and infraspinatus and reduction of external rotation moment arm of the deltoid in reverse arthroplasty, significant recovery of external rotation may not occur, although an intact teres minor may assist external rotation in the elevated position. Conclusion Improving the efficiency of deltoid function before and after reverse shoulder arthroplasty is a key factor in the rehabilitation of the cuff deficient shoulders. Performing exercises in scapular plane and higher abduction angles activates deltoid and other important muscles more efficiently and optimizes surgical outcomes.
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Affiliation(s)
- Helen Razmjou
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Varda van Osnabrugge
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark Anunciacion
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Nunn
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Darren Drosdowech
- Roth
- McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Western University, London, Ontario, Canada
| | - Ania Roszkowski
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Analia Szafirowicz
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dragana Boljanovic
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy Wainwright
- Holland Bone and Joint Program, Holland Orthoapaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Diane Nam
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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24
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Gamma camera imaging (bone scan) in orthopedics: Wrist, elbow and shoulders. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Townsend CB, Wright J, Wright TW, Pazik M, Schoch B, Gil J, King JJ. Severe acromioclavicular joint osteoarthritis is associated with acromial stress fractures after reverse shoulder arthroplasty. JSES Int 2021; 6:236-240. [PMID: 35252919 PMCID: PMC8888166 DOI: 10.1016/j.jseint.2021.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Little is known about the role of disorders of the acromioclavicular joint (ACJ) and how they relate to complications after reverse shoulder arthroplasty (RSA). The purpose of this study is to compare the severity of ACJ osteoarthritis in patients undergoing RSA with and without postoperative acromial and scapular spine fractures. Methods A retrospective review was performed to identify all patients who underwent primary RSA between 1/1/2007 and 10/31/2019 with a postoperative acromial or scapular spine stress fracture from a single institution. Patients who underwent RSA with a fracture were compared with an age-, sex-, and preoperative diagnosis-matched control group (1:4 controls) with a minimum 2-year follow-up. We compared demographics, medical comorbidities, and ACJ osteoarthritis between the 2 groups. Preoperative radiographs and 3-dimensional computed tomography scans were evaluated for ACJ osteoarthritis in all patients. The Petersson classification, a modified Petersson classification, location of the osteophytes, subchondral cysts, ACJ space, and size of the largest osteophyte were recorded and compared between the 2 groups. Results The study included 11 patients who underwent primary RSA (8 women and 3 men) with acromial (6) and scapular spine (5) fractures confirmed radiographically and 44 matched controls (average follow-up 3.1 vs. 4.3 years, P = .17). Average age at surgery was similar between study and control groups (69.6 vs. 70.0 years, P = .86). ACJ osteoarthritis with osteophytes larger than 2 mm was common and similar between the 2 groups (91% of patients with acromial fracture and 66% of controls, P = .15). There was no significant difference in the size or location of the ACJ osteophytes. The Petersson classification was similar between groups. However, the percentage of patients with subchondral ACJ cysts was higher in the fracture group (91% vs. 50%, P = .02), and the percentage of patients with large spanning or fused osteophytes was significantly higher in the fracture group (55% vs. 14%, P = .008). Conclusion Radiographic ACJ osteoarthritis is common in patients undergoing RSA. Severe ACJ osteoarthritis with completely spanning or fused osteophytes may predispose patients to acromial or scapular spine fractures after RSA.
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Lateralization in Reverse Shoulder Arthroplasty. J Clin Med 2021; 10:jcm10225380. [PMID: 34830659 PMCID: PMC8623532 DOI: 10.3390/jcm10225380] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/05/2022] Open
Abstract
Indications for Reverse Shoulder Arthroplasty (RSA) have been extended over the last 25 years, and RSA has become the most frequently implanted shoulder arthroplasty worldwide. The initial Grammont design with medialization of the joint center of rotation (JCOR), placement of the JCOR at the bone–implant interface, distalization and semi-constrained configuration has been associated with drawbacks such as reduced rotation and range of motion (ROM), notching, instability and loss of shoulder contour. This review summarizes new strategies to overcome these drawbacks and analyzes the use of glenoid-sided, humeral-sided or global bipolar lateralization, which are applied differently by surgeons and current implant manufacturers. Advantages and drawbacks are discussed. There is evidence that lateralization addresses the initial drawbacks of the Grammont design, improving stability, rates of notching, ROM and shoulder contour, but the ideal extent of lateralization of the glenoid and humerus remains unclear, as well as the maximal acceptable joint reaction force after reduction. Overstuffing and spine of scapula fractures are potential risks. CT-based 3D planning as well as artificial intelligence will help surgeons with planning and execution of appropriate lateralization in RSA. Long-term follow-up of lateralization with new implant designs and implantation strategies is needed.
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27
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Huang Y, Ernstbrunner L, Robinson DL, Lee PVS, Ackland DC. Complications of Reverse Total Shoulder Arthroplasty: A Computational Modelling Perspective. J Clin Med 2021; 10:5336. [PMID: 34830616 PMCID: PMC8625535 DOI: 10.3390/jcm10225336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Reverse total shoulder arthroplasty (RTSA) is an established treatment for elderly patients with irreparable rotator cuff tears, complex proximal humerus fractures, and revision arthroplasty; however, with the increasing indications for RTSA over the last decade and younger implant recipients, post-operative complications have become more frequent, which has driven advances in computational modeling and simulation of reverse shoulder biomechanics. The objective of this study was to provide a review of previously published studies that employed computational modeling to investigate complications associated with RTSA. Models and applications were reviewed and categorized into four possible complications that included scapular notching, component loosening, glenohumeral joint instability, and acromial and scapular spine fracture, all of which remain a common cause of significant functional impairment and revision surgery. The computational shoulder modeling studies reviewed were primarily used to investigate the effects of implant design, intraoperative component placement, and surgical technique on postoperative shoulder biomechanics after RTSA, with the findings ultimately used to elucidate and mitigate complications. The most significant challenge associated with the development of computational models is in the encapsulation of patient-specific anatomy and surgical planning. The findings of this review provide a basis for future direction in computational modeling of the reverse shoulder.
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Affiliation(s)
- Yichen Huang
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia; (Y.H.); (L.E.); (D.L.R.); (P.V.S.L.)
| | - Lukas Ernstbrunner
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia; (Y.H.); (L.E.); (D.L.R.); (P.V.S.L.)
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
- Melbourne Orthopaedic Group, Windsor, VIC 3181, Australia
| | - Dale L. Robinson
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia; (Y.H.); (L.E.); (D.L.R.); (P.V.S.L.)
| | - Peter Vee Sin Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia; (Y.H.); (L.E.); (D.L.R.); (P.V.S.L.)
| | - David C. Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia; (Y.H.); (L.E.); (D.L.R.); (P.V.S.L.)
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Kerrigan AM, Reeves J, Langohr GDG, Johnson JA, Athwal GS. Reverse shoulder arthroplasty glenoid lateralization influences scapular spine strains. Shoulder Elbow 2021; 13:610-619. [PMID: 34804210 PMCID: PMC8600669 DOI: 10.1177/1758573220935567] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Scapular spine insufficiency fractures following reverse shoulder arthroplasty are poorly understood. There exists limited literature regarding the role of reverse shoulder arthroplasty lateralization on scapular spine strains and fractures. The purpose of this cadaveric biomechanical simulator study was to evaluate the role of glenoid lateralization on scapular spine strain. METHODS Eight cadaveric shoulders were tested using an in-vitro simulator. A custom modular reverse shoulder arthroplasty was implanted that allowed for in-situ glenoid lateralization adjustment. Scapular spine strain was measured by strain gauges placed in clinically relevant Levy zones along the scapular spine. All specimens were tested in loaded forward elevation and abduction. RESULTS Glenoid lateralization from 0 to 5 mm caused negligible changes in scapular spine strains. Lateralization from 5 to 10 mm, however, caused significant increases in strain at 0° forward elevation in all strain gauges (p < 0.026). Strains measured in Levy zone 2 were significantly higher than all other locations (p < 0.039). Additionally, forward elevation resulted in significantly higher strain values than abduction (p = 0.001). CONCLUSIONS Glenoid lateralization is an important parameter in reverse shoulder arthroplasty; however, our results demonstrate higher degrees of lateralization may place higher strains on the scapular spine. An understanding of reverse shoulder arthroplasty lateralization and scapular spine strains is important to optimize parameters and to mitigate negative effects. LEVEL OF EVIDENCE Basic Sciences Study, Cadaveric Model, Biomechanics.
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Affiliation(s)
| | | | | | | | - George S Athwal
- George S Athwal, St Joseph's Health Care, PO Box
5777, STN B, London, Ontario N6A 4V2, Canada.
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29
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Mahendraraj KA, Abboud J, Armstrong A, Austin L, Brolin T, Entezari V, Friedman L, Garrigues GE, Grawe B, Gulotta L, Gutman M, Hart PA, Hobgood R, Horneff JG, Iannotti J, Khazzam M, King J, Kloby MA, Knack M, Levy J, Murthi A, Namdari S, Okeke L, Otto R, Parsell DE, Polisetty T, Ponnuru P, Ricchetti E, Tashjian R, Throckmorton T, Townsend C, Wright M, Wright T, Zimmer Z, Menendez ME, Jawa A. Predictors of acromial and scapular stress fracture after reverse shoulder arthroplasty: a study by the ASES Complications of RSA Multicenter Research Group. J Shoulder Elbow Surg 2021; 30:2296-2305. [PMID: 33677115 DOI: 10.1016/j.jse.2021.02.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/31/2021] [Accepted: 02/08/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acromial (ASF) and scapular spine (SSF) stress fractures are well-recognized complications of reverse shoulder arthroplasty (RSA), but much of the current data are derived from single-center or single-implant studies with limited generalizability. This study from the American Shoulder and Elbow Surgeons (ASES) Complications of Reverse Shoulder Arthroplasty Multicenter Research Group determined the incidence of ASF/SSF after RSA and identified preoperative patient characteristics associated with their occurrence. METHOD Fifteen institutions including 21 ASES members across the United States participated in this study. Patients undergoing either primary or revision RSA between January 2013 and June 2019 with a minimum 3-month follow-up were included. All definitions and inclusion criteria were determined using the Delphi method, an iterative survey process involving all primary investigators. Consensus was achieved when at least 75% of investigators agreed on each aspect of the study protocol. Only symptomatic ASF/SSF diagnosed by radiograph or computed tomography were considered. Multivariable logistic regression was performed to identify factors associated with ASF/SSF development. RESULTS We identified 6755 RSAs with an average follow-up of 19.8 months (range, 3-94). The total stress fracture incidence rate was 3.9% (n = 264), of which 3.0% (n = 200) were ASF and 0.9% (n = 64) were SSF. Fractures occurred at an average 8.2 months (0-64) following RSA with 21.2% (n = 56) following a trauma. Patient-related factors independently predictive of ASF were chronic dislocation (odds ratio [OR] 3.67, P = .04), massive rotator cuff tear without arthritis (OR 2.51, P < .01), rotator cuff arthropathy (OR 2.14, P < .01), self-reported osteoporosis (OR 2.21, P < .01), inflammatory arthritis (OR 2.18, P < .01), female sex (OR 1.51, P = .02), and older age (OR 1.02 per 1-year increase, P = .02). Factors independently associated with the development of SSF included osteoporosis (OR 2.63, P < .01), female sex (OR 2.34, P = .01), rotator cuff arthropathy (OR 2.12, P = .03), and inflammatory arthritis (OR 2.05, P = .03). CONCLUSION About 1 in 26 patients undergoing RSA will develop a symptomatic ASF or SSF, more frequently within the first year of surgery. Our results indicate that severe rotator cuff disease may play an important role in the occurrence of stress fractures following RSA. This information can be used to counsel patients about potential setbacks in recovery, especially among older women with suboptimal bone health. Strategies for prevention of ASF and SSF in these at-risk patients warrant further study. A follow-up study evaluating the impact of prosthetic factors on the incidence rates of ASF and SSF may prove highly valuable in the decision-making process.
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Affiliation(s)
| | - Kuhan A Mahendraraj
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA
| | - Joseph Abboud
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | | | - Luke Austin
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Tyler Brolin
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, Memphis, TN, USA
| | - Vahid Entezari
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Brian Grawe
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | - Paul-Anthony Hart
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA
| | - Rhett Hobgood
- Mississippi Sports Medicine and Orthopaedic Surgery, Jackson, MS, USA
| | | | - Joseph Iannotti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joseph King
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael A Kloby
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Margaret Knack
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, Memphis, TN, USA
| | - Jon Levy
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | - Anand Murthi
- MedStar Union Memorial Hospital, Baltimore, MD, USA
| | | | | | - Randall Otto
- St. Louis University Care Physician Group, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Douglas E Parsell
- Mississippi Sports Medicine and Orthopaedic Surgery, Jackson, MS, USA
| | - Teja Polisetty
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | | | - Eric Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Tashjian
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Thomas Throckmorton
- Department of Orthopaedic Surgery and Biomedical Engineering, Campbell Clinic, Memphis, TN, USA
| | - Clay Townsend
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Thomas Wright
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Zachary Zimmer
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA.
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Baek Md CH, Kim Md JG, Lee Md DH, Baek GR. Does Preservation of Coracoacromial Ligament Reduce the Acromial Stress Pathology Following Reverse Total Shoulder Arthroplasty? J Shoulder Elb Arthroplast 2021; 5:24715492211022171. [PMID: 34497968 PMCID: PMC8282135 DOI: 10.1177/24715492211022171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Acromial pathologies (AP), such as acromial stress reaction (ASR), acromial stress occult fracture (ASOF), and acromial stress fracture (ASF), are known as complications that deteriorate the clinical score and patient satisfaction after reverse total shoulder arthroplasty (RSA). Several factors that increase stress on the acromion have been reported as risk factors for AP, but this is also unclear. Thecoracoacromial ligament (CAL) is a structure that distributes the stress loading on such an acromion, although its importance has been mentioned, there is a lack of research. Therefore, we investigated the incidence of AP according to the preservation of the CAL and whether it is a risk factor. Methods The study was retrospectively conducted on patients who underwent RSA from 2016 and 2018. Patients with CAL transection was classified into group 1 and CAL preservation was classified into group 2. ASR and ASOF were identified through symptoms and ultrasound, and ASF identified through simple radiograph or computed tomography. The incidence of AP in each group was checked and compared. Results Of the total of 265 patients. Among 197 cases of group 1, 21 cases of ASR(10.7%), 28 cases of ASOF (14.2%),10 cases of ASF (5.1%), and 59 cases of total AP (29.4%). Among 68 cases in group 2, 2 cases (2.9%) of ASR, 6 cases of ASOF(8.8%), 1 case of ASF (1.5%), and 9 cases of total AP (13.2%). It was confirmed that ASR and ASOP were significantly decreased in the group preserving CAL. (P = .008) Conclusion In the case of preservation of CAL during surgery, it was confirmed that the incidence of ASR, ASOF was reduced. Therefore, preservation of CAL can be regarded as a modifiable risk factor that can reduce the risk of AP by distributing the stress applied to acromion after RSA surgery.
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Affiliation(s)
- Chang Hee Baek Md
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Jung Gon Kim Md
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Dong Hyeon Lee Md
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
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31
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Tat J, Sheth U, Nam D. Scapular Notching Following Ipsilateral Traumatic Clavicle Fracture in Reverse Total Shoulder Arthroplasty: A Case Report. J Shoulder Elb Arthroplast 2021; 5:24715492211020694. [PMID: 34497967 PMCID: PMC8282161 DOI: 10.1177/24715492211020694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Reverse total shoulder arthroplasty (RTSA) procedures are becoming increasingly more common. While the main complications are known, the management of clavicle fractures in patients with an ipsilateral RTSA is not well described. There are three case studies that document clavicular stress fractures following RTSA with an atraumatic etiology, and to our knowledge, no studies have described a traumatic clavicular fracture following RTSA. Case We describe the case of a 75-year-old woman with a traumatic clavicle fracture five years after RTSA for rotator cuff tear arthropathy. With minimal pain and subjective symptoms initially, the patient wished to pursue non-operative treatment. However, she eventually developed a painful non-union and pseudoparalysis of the shoulder with serial radiographs demonstrating progressive superior scapular tilting and scapular notching. Subsequent open reduction internal fixation of her clavicle fracture significantly improved her pain and function. Conclusion We report a traumatic clavicle fracture in the setting of RTSA that not only failed to heal but also resulted in scapular notching and shoulder pseudoparalysis that was improved with surgical stabilization of the fracture. It is possible that the setting of a semi-constrained RTSA, the resulting biomechanical imbalance may predispose to impaired fracture healing and non-union of the clavicle fracture.
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Affiliation(s)
- Jimmy Tat
- Sunnybrook Orthopaedic Upper Limb (SOUL), Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ujash Sheth
- Sunnybrook Orthopaedic Upper Limb (SOUL), Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Diane Nam
- Sunnybrook Orthopaedic Upper Limb (SOUL), Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Eroğlu ON, Hüsemoğlu B, Başçı O, Özkan M, Havıtçıoğlu H, Hapa O. Scapular spine base fracture with long outside-in superior or posterior screws with reverse shoulder arthroplasty. Clin Shoulder Elb 2021; 24:141-146. [PMID: 34488294 PMCID: PMC8423534 DOI: 10.5397/cise.2021.00213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of the present study was to determine how long superior screws alone or in combination with posterior placement of metaglene screws protruding and penetrating into the scapular spine in reverse total shoulder arthroplasty affect the strength of the scapular spine in a fresh cadaveric scapular model. Methods Seven fresh cadaver scapulas were allocated to the control group (short posterior and superior screws) and seven scapulars to the study group (spine base fixation with a four long screws, three with both long superior and long posterior screws). Results The failure load was lower in the spine fixation group (long screw, 869 N vs. short screw, 1,123 N); however, this difference did not reach statistical significance (p>0.05). All outside-in long superior or superior plus posterior screws failed due to scapular spine base fracture; failures in the short screw group were due to acromion fracture. An additional posterior outside-in screw failed to significantly decrease the failure load of the acromion spine. Conclusions The present study highlights the significance of preventing a cortical breach or an outside-in configuration when a superior or posterior screw is inserted into the scapular spine base.
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Affiliation(s)
- Osman Nuri Eroğlu
- Department of Orthopedics and Traumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey.,Department of Biomechanics, Graduate School of Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Buğra Hüsemoğlu
- Department of Biomechanics, Graduate School of Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Onur Başçı
- Department of Orthopedics and Traumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Mustafa Özkan
- Department of Orthopedics and Traumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Hasan Havıtçıoğlu
- Department of Orthopedics and Traumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey.,Department of Biomechanics, Graduate School of Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Onur Hapa
- Department of Orthopedics and Traumatology, Dokuz Eylül University School of Medicine, İzmir, Turkey
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33
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Colliton EM, Jawa A, Kirsch JM. Acromion and Scapular Spine Fractures Following Reverse Total Shoulder Arthroplasty. Orthop Clin North Am 2021; 52:257-268. [PMID: 34053571 DOI: 10.1016/j.ocl.2021.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Reverse total shoulder arthroplasty (RSA) continues to see tremendous growth as the indications have expanded. A variety of complications have been described, including fractures of the acromion or scapular spine. These fractures are painful and can compromise shoulder stability and functional outcomes following RSA. Multiple studies have recently investigated the incidence, risk factors, and treatment strategies for these injuries. In this article, the authors review current literature and discuss the incidence, cause, associated risk factors, treatment options, and outcomes following fractures of the acromion or scapular spine after RSA.
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Affiliation(s)
- Eileen M Colliton
- Department of Orthopaedic Surgery, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA; Boston Sports and Shoulder Center, 840 Winter Street, Waltham, MA 02451, USA.
| | - Jacob M Kirsch
- Department of Orthopaedic Surgery, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA; Boston Sports and Shoulder Center, 840 Winter Street, Waltham, MA 02451, USA
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Abstract
A consensus is beginning to emerge about the indications for fixation of fractures involving the glenoid fossa of the scapula. The same cannot be firmly said for extra-articular fractures of the blade or the processes of the scapula, with a good deal of reliance on expert opinion from high-volume centres. There are no randomized controlled studies and the systematic reviews that do exist can only pool the data from available case series, making meaningful meta-analysis of limited value. Interest in scapula fractures has increased of late due to the specific association of fractures of the scapular spine and acromion with reverse shoulder arthroplasty. This review summarizes the available evidence that can assist decision making when faced with a patient with a scapula fracture. Which patients should at least be considered for open reduction and internal fixation, either in the centre where they present or after referral to a more specialist centre? These patients are those with a fracture sufficiently displaced that it interferes with the mechanical function of the shoulder girdle and the aim of fixation is to reduce pain and disability. Since the majority of scapula fractures heal quickly with non-surgical treatment and do not cause significant disability, decision making can be difficult, and it is perhaps the case that it is easier to err on the side of caution. However, it seems that there are fracture types, such as significantly displaced double disruptions of the superior suspensory complex, widely displaced lateral column fractures and fractures producing angular deformity of the glenoid process, that benefit from early reduction and stabilization with the expectation of a good outcome for the patient.
Cite this article: EFORT Open Rev 2021;6:518-525. DOI: 10.1302/2058-5241.6.210010
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Affiliation(s)
- David Limb
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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35
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Yeazell ST, Malige A, Visser T, Carolan GF. The role of acromial morphometry in the development of acromial stress fracture following reverse total shoulder arthroplasty. Shoulder Elbow 2021; 13:296-302. [PMID: 34659470 PMCID: PMC8512991 DOI: 10.1177/1758573220906764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Indications for reverse total shoulder arthroplasty are expanding, and postoperative acromial stress fractures are a troubling postoperative complication. The purpose of this study was to determine if differences in acromial morphometry were present between cohorts with and without this complication. METHODS A retrospective review of 101 reverse total shoulder arthroplasty procedures met criteria for the study. A total of eight acromial measurements on preoperative computed tomography scans were performed in axial, coronal, and sagittal views. Postoperative acromial stress fractures were confirmed by computed tomography scan on six patients and classified by fracture type. Statistical analysis was performed using a Mann-Whitney U test. RESULTS The median acromial thickness at the posterior and lateral half was significantly thinner in the fracture cohort compared to the non-fracture cohort. Fracture and non-fracture cohort measurements demonstrated a median lateral thickness of 6.8 and 8.7 mm (p = 0.010), respectively, and median posterior thickness of 7.6 and 9.5 mm (p = 0.008), respectively. There were no demographic differences between cohorts. DISCUSSION Two acromial measurements (lateral and posterior thickness) were associated with the development of postoperative acromial stress fracture following reverse total shoulder arthroplasty. These findings suggest that a thinner acromion in the lateral and posterior half is a risk factor for an acromial stress fracture following reverse total shoulder arthroplasty.
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Affiliation(s)
- Shawn T Yeazell
- Shawn T Yeazell, Department of Orthopedic
Surgery, St Luke’s University Health Network, 801 Ostrum St. PPHP2, Bethlehem,
PA 18018, USA.
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Charilaou J, Dey R, Burger M, Sivarasu S, van Staden R, Roche S. Quantitative fit analysis of acromion fracture plating systems using three-dimensional reconstructed scapula fractures - A multi-observer study. SICOT J 2021; 7:36. [PMID: 34014164 PMCID: PMC8136237 DOI: 10.1051/sicotj/2021028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/17/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Surgical treatment of displaced acromial and scapula spine fractures may be challenging due to the bony anatomy and variable fracture patterns. This difficulty is accentuated by the limitations of the available scapular plates for fracture fixation. This study compares the quantitative fitting of anatomic scapular plates and clavicle plates, using three-dimensional (3D) printed fractured scapulae. METHODS Fourteen scapulae with acromion and spine fractures were used for this study. Computerized tomographic (CT) scans of the fractured scapulae were obtained from the Philips picture archiving and communication system (PACS) database of patients admitted to a tertiary teaching hospital in Cape Town, South Africa between 2012 and 2016. The reconstructed scapulae were 3D printed and the anatomical acromion and clavicle plates were templated about the fracture regions. The fit assessment was performed by five observers who classified the plates as no-fit, intermediate fit, and anatomical fit according to the surgical guidelines. RESULTS The 6-hole anterior clavicle plate performed better than any of the scapular plates as they were able to fit 45.7% of the fractured acromion, including the spine. Among the pre-contoured anatomical scapula plates, both the short and the long acromion plates could fit only 27.3% of the fractured acromion. The intraclass correlation coefficient was 0.965 suggesting excellent consensus among the five observers. CONCLUSION Clavicle plates were found to be better suited to fit around a scapula fracture in its acromion and spine region.
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Affiliation(s)
- Johan Charilaou
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa
| | - Roopam Dey
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, 7935 Cape Town, South Africa
| | - Marilize Burger
- Faculty of Medicine and Health Sciences, Division of Orthopaedic Surgery, Stellenbosch University, 7935 Cape Town, South Africa
| | - Sudesh Sivarasu
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, 7935 Cape Town, South Africa
| | - Ruan van Staden
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa
| | - Stephen Roche
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa
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Kozak T, Bauer S, Walch G, Al-Karawi S, Blakeney W. An update on reverse total shoulder arthroplasty: current indications, new designs, same old problems. EFORT Open Rev 2021; 6:189-201. [PMID: 33841918 PMCID: PMC8025709 DOI: 10.1302/2058-5241.6.200085] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Reverse total shoulder arthroplasty (RTSA) was originally developed because of unsatisfactory results with anatomic shoulder arthroplasty options for the majority of degenerative shoulder conditions and fractures. After initial concerns about RTSA longevity, indications were extended to primary osteoarthritis with glenoid deficiency, massive cuff tears in younger patients, fracture, tumour and failed anatomic total shoulder replacement. Traditional RTSA by Grammont has undergone a number of iterations such as glenoid lateralization, reduced neck-shaft angle, modular, stemless components and onlay systems. The incidence of complications such as dislocation, notching and acromial fractures has also evolved. Computer navigation, 3D planning and patient-specific implantation have been in use for several years and mixed-reality guided implantation is currently being trialled. Controversies in RTSA include lateralization, stemless humeral components, subscapularis repair and treatment of acromial fractures.
Cite this article: EFORT Open Rev 2021;6:189-201. DOI: 10.1302/2058-5241.6.200085
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Affiliation(s)
- Thomas Kozak
- Albany Health Campus, Albany, Australia.,Royal Perth Hospital, Perth, Australia
| | - Stefan Bauer
- Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - Gilles Walch
- Hôpital Privé Jean-Mermoz, Centre Orthopédique Santy, Lyon, France
| | | | - William Blakeney
- Albany Health Campus, Albany, Australia.,Royal Perth Hospital, Perth, Australia
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Vance DD, O'Donnell JA, Baldwin EL, Cheah JW, Pereira G, Klifto C, Lassiter TE, Anakwenze OA. Risk of suprascapular nerve injury during glenoid baseplate fixation for reverse total shoulder arthroplasty: a cadaveric study. J Shoulder Elbow Surg 2021; 30:532-537. [PMID: 32707330 DOI: 10.1016/j.jse.2020.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (rTSA) is an effective treatment for patients with advanced rotator cuff arthropathy. During implantation of the glenoid baseplate, screws are inserted through the glenoid face into the scapular body to achieve adequate fixation. Placement of peripheral baseplate screws in the superior and posterior glenoid may increase the risk of injury to the suprascapular nerve (SSN). The purpose of this cadaveric study was to evaluate the risk of SSN injury with placement of baseplate screws in the superior and posterior direction. METHODS Twelve cadaveric shoulders were implanted with glenoid baseplates. A bicortical 44-mm screw was placed in both the superior and posterior glenoid baseplate screw holes. Following implantation, the SSN was dissected and visualized through a posterior shoulder approach. The distance from the tip of the screws to the SSN and the distance from the screw's scapular exiting hole to the SSN was recorded. Average distances were calculated for each measurement. RESULTS The superior screw contacted the SSN in 8 of the 12 specimens (66%). For the superior screw, the average distance from the exiting point in the scapula to the SSN was 9.2 ± 6.3 mm, with the shortest distance being 3.9 mm. The posterior screw contacted the SSN in 6 of 12 specimens (50%). For the posterior screw, the average distance from the exiting point to the SSN was 8.9 ± 3.8 mm, with the shortest distance to the nerve being 2.2 mm. CONCLUSION Placement of the superior and posterior screws in the glenoid baseplate during rTSA risks injury to the SSN. The safe zone for superior- and posterior-directed baseplate screw is <2 mm from its exiting point on the scapula. Therefore, precise measurements of screw lengths in this area is important in avoiding injury to the SSN.
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Affiliation(s)
- Danica D Vance
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Jeffrey A O'Donnell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Edward L Baldwin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jonathan W Cheah
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Gregory Pereira
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Tally E Lassiter
- Department of Orthopaedic Surgery, Duke University Medical Center, Raleigh, NC, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Kerrigan AM, Reeves JM, Langohr GDG, Johnson JA, Athwal GS. The influence of reverse arthroplasty humeral component design features on scapular spine strain. J Shoulder Elbow Surg 2021; 30:572-579. [PMID: 32621980 DOI: 10.1016/j.jse.2020.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/25/2020] [Accepted: 06/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) humeral implant parameters have been previously studied with respect to range of motion, deltoid function, and stability. However, limited literature exists on the influence of humeral design features on scapular spine strain. The purpose of this cadaveric biomechanical simulator study was to evaluate the role of humeral component lateralization and neck-shaft angle (NSA) on scapular spine strain. METHODS Eight fresh-frozen cadaveric shoulders were tested using an in vitro shoulder simulator. A custom-designed modular RSA system was implanted that allowed for the in situ adjustment of humeral lateralization and NSA. Scapular spine strain was measured by strain gauges placed along the acromion and scapular spine in clinically relevant positions representative of the Levy fracture zones. All testing was conducted in both abduction and forward elevation. RESULTS In Levy zones 2 and 3, increasing humeral lateralization caused significant incremental decreases in scapular spine strain at 0° and 90° abduction (P < .042). Strain decreases as high as 34% were noted with increases in humeral lateralization from -5 to 15 mm (P = .042). Changing NSA had no statistically significant effect on scapular spine strain (P > .14). CONCLUSIONS Some humeral implant design features in RSA have effects on scapular spine strain. Humeral component lateralization had significant effects, whereas adjusting NSA resulted in no substantial differences in scapular spine strain. Understanding humeral component variables is important to allow for design optimization of future RSA implants.
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Affiliation(s)
- Alicia M Kerrigan
- Investigations conducted at the Bioengineering Laboratory at the Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Jacob M Reeves
- Investigations conducted at the Bioengineering Laboratory at the Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - G Daniel G Langohr
- Investigations conducted at the Bioengineering Laboratory at the Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - James A Johnson
- Investigations conducted at the Bioengineering Laboratory at the Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - George S Athwal
- Investigations conducted at the Bioengineering Laboratory at the Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.
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Colley R, Polisetty TS, Levy JC. Mid-term outcomes of reverse shoulder arthroplasty using the alternative center line for glenoid baseplate fixation: a case-controlled study. J Shoulder Elbow Surg 2021; 30:298-305. [PMID: 32862995 DOI: 10.1016/j.jse.2020.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND A critical step in reverse shoulder arthroplasty (RSA) is glenoid baseplate fixation. In cases of glenoid bone loss, use of the anatomic glenoid center line may not provide sufficient bone support for fixation. Anteversion along the alternative center line is a described method for achieving baseplate fixation in these cases. However, concern remains regarding negative consequences in functional outcomes and complications. The purpose of this study was to compare the outcomes of RSA using the anatomic or alternative center line. METHODS We performed a retrospective case-controlled study of patients who underwent RSA between November 2006 and August 2017, performed by a single surgeon, with a minimum of 2 years' follow-up. Patients treated with the anatomic center-line technique for baseplate fixation were matched 3:1 based on sex, indication for surgery, and age with patients treated with the alternative center-line technique. Patient-reported outcome measures (PROMs), active range of motion, and the ability to perform functional tasks of internal rotation were compared. Evaluations of the most recently obtained radiographs focused on acromial fractures, scapular notching, and glenoid loosening. RESULTS A total of 88 patients (66 in anatomic center-line group and 22 in alternative group) participated in the matched analysis, with a mean age of 74.2 years (range, 58-89 years) and mean follow-up period of 53 months (range, 24-130 months). At the final follow-up, we found no significant differences in PROMs, including the Simple Shoulder Test score (P = .829), American Shoulder and Elbow Surgeons score (P = .601), visual analog scale pain score (P = .068), and Single Assessment Numeric Evaluation score (P = .674). Moreover, both the overall improvements in these PROMs and all active motions and functional tasks of internal rotation were not different. No radiographic evidence of glenoid loosening was found in either group, and 2 patients in each cohort (3% of the anatomic group and 9% of the alternative group) experienced an acromial fracture. Low-grade scapular notching developed in 15.2% of the anatomic group and 18.2% of the alternative center line group (P = .736). CONCLUSION The alternative center line can be used for baseplate fixation in the setting of glenoid bone loss and leads to similar patient outcomes and functional tasks of internal rotation, as well as a low rate of complications, compared with the anatomic center line following RSA.
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Affiliation(s)
- Ryan Colley
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
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Ting FSH, Lockhart JS, Axford D, Johnson JA, Langohr DG, Athwal GS. Comparing internal fixation constructs for scapular spine insufficiency fractures following reverse shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:172-177. [PMID: 32788041 DOI: 10.1016/j.jse.2020.04.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION There is limited research on the surgical management techniques for scapular spine fractures after reverse shoulder arthroplasty (RTSA). As such, the purpose of this in vitro biomechanical study was to compare 4 fixation constructs to stabilize scapular spine insufficiency fractures. METHODS Twelve paired fresh-frozen cadaveric scapulae (N = 24) were randomized into 4 fixation groups: subcutaneous border plating (± hook) and supraspinatus fossa plating (± hook). A Levy type II fracture was simulated. Each specimen was cyclically loaded incrementally up to 700 N in 50 N steps or until failure. Between 50 and 200 N construct stiffness was measured, and stability failure was defined as displacement greater than 2.5 mm. RESULTS Seventy-nine percent (19 of 24) of the specimens failed before the maximum load of 700 N. The average survival force with subcutaneous border plating was 480 ± 80 N compared with 380 ± 30 N for supraspinatus fossa plating (P = .3). Fixation construct failure was significantly more likely with fossa plating over subcutaneous plating (P = .012). The presence of the lateral plate hook was beneficial in preventing failure of the lateral acromion (P = .016). CONCLUSION When appropriately surgically indicated, a dorsally applied plate to the subcutaneous border of the scapular spine with a lateral inferior supporting hook may be advantageous for internal fixation of type II scapular spine insufficiency fractures after RTSA.
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Affiliation(s)
- Francis S H Ting
- Roth/McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - Jason S Lockhart
- Roth/McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - David Axford
- Roth/McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - James A Johnson
- Roth/McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - Daniel G Langohr
- Roth/McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada
| | - George S Athwal
- Roth/McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada.
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Cho CH, Rhee YG, Yoo JC, Ji JH, Kim DS, Kim YS, Rhee SM, Kim DH. Incidence and risk factors of acromial fracture following reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:57-64. [PMID: 32807375 DOI: 10.1016/j.jse.2020.04.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/07/2020] [Accepted: 04/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The occurrence and related predictors of acromial fracture following reverse total shoulder arthroplasty (RTSA) have not been fully elucidated. The aim of this study was to determine the incidence and risk factors of acromial fractures after RTSA. METHODS We conducted a multicenter, retrospective case-control study of 787 cases (29 in acromial fracture group and 758 in control group) that underwent RTSA performed by 6 surgeons. The mean duration of follow-up after RTSA was 31.6 ± 21.8 months (range, 12-136 months). Demographic variables (age, sex, arm dominance, body mass index, working status, bone mineral density [BMD]), clinical variables (preoperative diagnosis, previous operation, implant design, preoperative clinical scores, screw size in glenoid fixation, postoperative rehabilitation), and radiographic variables (acromial thickness, critical shoulder angle, deltoid length, humeral offset to lateral acromion) were investigated. To determine risk correlation, univariate analysis and multivariate logistic regression analysis with calculated odds ratios (ORs) were performed. RESULTS Postoperative acromial fractures occurred in 29 of the 787 shoulders with RTSA (3.7%). Acromial fractures were detected at a mean of 10.0 months (range, 1-66 months) postoperatively. Univariate analysis revealed that the occurrence of an acromial fracture was significantly associated with a previous operation (38% [11 of 29] vs. 21% [156 of 758], P = .025) and BMD (-2.33 vs. -1.74, P = .013). Multivariate logistic regression analysis found that the occurrence of a postoperative acromial fracture was significantly associated with a previous operation (P = .034; OR, 2.91; 95% confidence interval, 1.08-7.84) and deltoid length (P = .004; OR, 1.04; 95% confidence interval, 1.01-1.07). CONCLUSION Acromial fracture following RTSA is not an uncommon complication, with an overall incidence of 3.7%. A previous operation, increased deltoid length, and low BMD were risk factors of acromial fracture following RTSA.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Yong Girl Rhee
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Republic of Korea
| | - Doo-Sup Kim
- Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea Seoul, Republic of Korea
| | - Sung-Min Rhee
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Republic of Korea.
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Khwaja A, Sherman N, Knox A, Mahoney A. Late presentation of acromial base fracture after reverse shoulder arthroplasty: a case report. JSES Int 2020; 5:266-269. [PMID: 33681847 PMCID: PMC7910745 DOI: 10.1016/j.jseint.2020.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ansab Khwaja
- Department of Orthopedic Surgery, University of Arizona, Tucson, AZ, USA
- Corresponding author: Ansab Khwaja, MD, Department of Orthopedic Surgery, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA.
| | - Nathan Sherman
- Department of Orthopedic Surgery, University of Arizona, Tucson, AZ, USA
| | - Andrew Knox
- Tucson Orthopaedic Institute, Tucson, AZ, USA
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Verstraete O, Van der Mast B, Van Tongel A, Karelse A, Van der Bracht H, Berghs B, Van Isacker T, Verniers P, De Wilde L. Prevalence and risk factors of scapular stress fracture after reverse shoulder arthroplasty: a multicentric retrospective study. INTERNATIONAL ORTHOPAEDICS 2020; 45:209-216. [PMID: 33185725 DOI: 10.1007/s00264-020-04849-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Scapular stress fracture (sSF) is a difficult complication to treat after reverse total shoulder arthroplasty (RSA). The aim of this study was to identify the prevalence and possible risk factors in a large population. METHODS A total of 2165 RSAs that were implanted between January 2006 and October 2017 in five hospitals were evaluated. Within this cohort, sSF was radiologically confirmed. Age, gender, surgical indication and hospital of treatment were determined for the entire cohort. A matched 3:1 case-control study was then performed to investigate several clinical and surgical variables. RESULTS sSF occurred in 3.1% (63 patients), with a median time interval of five months post-operative [IQR = 9, range: (1-79)]. Within the entire cohort, females (OR = 2.99) and rotator cuff arthropathy (RCA) (OR = 2.79) were more prone to this complication. Age had little influence (OR = 1.03). After exclusion, fifty-five eligible cases were matched to 165 controls based on hospital, gender, age and surgical indication. After univariable analysis, significance was obtained for osteopenia (P = 0.037), osteoporosis (P = 0.032), surgical approach (P = 0.002) and peri-operative acromioclavicular (AC) joint surgery (P = 0.035). Multivariate analysis demonstrated that osteopenia (OR = 3.94), osteoporosis (OR = 2.85) and a deltopectoral approach (OR = 3.70) were independent risk factors. CONCLUSION According to our findings, older women with poor bone quality and a history of RCA suffered more frequently from sSF. Anterolateral approach during surgery was a surgical protective factor, possibly due to the mobilization of the acromioclavicular joint. Although this study indicates who is at risk for sSF, further investigation for prevention of sSF in these patients is necessary.
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Affiliation(s)
- O Verstraete
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium.
| | - B Van der Mast
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium
| | - A Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
| | - A Karelse
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
| | - H Van der Bracht
- Department of Orthopaedic Surgery and Traumatology, General Hospital Sint-Lucas Ghent, Ghent, Belgium
| | - B Berghs
- Department of Orthopaedic Surgery and Traumatology, General Hospital Bruges, Bruges, Belgium
| | - T Van Isacker
- Department of Orthopaedic Surgery and Traumatology, General Hospital Bruges, Bruges, Belgium
| | - P Verniers
- Department of Orthopaedic Surgery and Traumatology, General Hospital Sint-Lucas Ghent, Ghent, Belgium
| | - L De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000, Ghent, Belgium
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Influence of implant design and parasagittal acromial morphology on acromial and scapular spine strain after reverse total shoulder arthroplasty: a cadaveric and computer-based biomechanical analysis. J Shoulder Elbow Surg 2020; 29:2395-2405. [PMID: 32669200 DOI: 10.1016/j.jse.2020.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/28/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose was to analyze the influence of deltoid lengthening due to different implant designs and anatomic variations of the acromion and scapular spine (SS) in the parasagittal plane on strain patterns after reverse shoulder arthroplasty (RSA). METHODS Ten cadaveric shoulders with strain rosettes placed on the surface of the acromial body (Levy II) and SS (Levy III) were tested using a shoulder simulator. RSA using humeral onlay (+3, +5, +8, +10, +13 mm) and glenosphere lateralization (0, +6 mm) was performed. Arm lengthening and magnitude of strain on acromion/SS were measured. The length of deltoid was assessed using validated computer modeling. Anatomic variance of the SS angle and position of acromion in relation to the scapular plane was examined. For comparison of strain as a function of deltoid lengthening, 25 mm was used as a threshold value for comparison based on previous literature demonstrating a decrease in Constant score and active anterior elevation in patients with arm lengthening >25 mm. RESULTS At maximal deltoid lengthening (30.8 mm), average strains were 1112 με (acromion) and 1165 με (SS) (P < .01). There was an 82.6% increase in acromial strain at maximum lengthening compared with 25 mm (P = .02) and a strain increase of 79 με/mm deltoid lengthening above a threshold of 25 mm. The strain results delineated 2 anatomic groups: 5 of 10 specimens (group A) showed higher strain on SS (1445 με) vs. acromion (862 με, P = .02). Group A had a more posteriorly oriented acromion, whereas group B was anteriorly oriented (P < .001). CONCLUSION Deltoid lengthening above 25 mm produced large strains on the acromion/SS. Anatomic variation may indicate that as the acromion is more posteriorly oriented, the SS takes more strain from the deltoid vs. the acromion. Our study's data may help surgeons identify a high-risk population for increased strain patterns after RSA.
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Wright E, Tang Q, Ibrahim E. Scapular Spine Stress Fracture Following Reverse Total Shoulder Arthroplasty: Successful Management with Low-Intensity Pulsed Ultrasound. Cureus 2020; 12:e10978. [PMID: 33209534 PMCID: PMC7667614 DOI: 10.7759/cureus.10978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 11/05/2022] Open
Abstract
Scapular spine stress fractures are a rare but well-recognised complication following reverse total shoulder arthroplasty (RTSA). They present a challenge with no consensus on management. Both operative fixation and conservative measures are associated with high rates of mal- or non-union and decreased functional outcomes. We present the case of a 60-year-old female, who presented with a scapular spine fracture one year following RTSA. Treatment consisted of initial immobilisation, physiotherapy and the application of a portable low-intensity pulsed ultrasound (LIPUS) system (EXOGENÒ Ultrasound Bone Healing System, Bioventus, Durham NC, Netherlands). Following a three-month treatment course, there was a significant improvement in patient-reported pain and functional scores (Oxford Shoulder Score from 5/48 to 38/48). Sequential radiographic imaging confirmed fracture union. Clinicians may consider the use of LIPUS therapy as a potential adjunctive treatment modality to promote the union of scapular spine stress fractures following RTSA.
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Affiliation(s)
- Esther Wright
- Trauma and Orthopaedics, West Middlesex University Hospital, London, GBR
- Surgery, Imperial College London, London, GBR
| | - Quen Tang
- Trauma and Orthopaedics, West Middlesex University Hospital, London, GBR
| | - Edward Ibrahim
- Trauma and Orthopaedics, West Middlesex University Hospital, London, GBR
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Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review. INTERNATIONAL ORTHOPAEDICS 2020; 44:2673-2681. [PMID: 32995915 PMCID: PMC7679357 DOI: 10.1007/s00264-020-04813-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 09/15/2020] [Indexed: 12/25/2022]
Abstract
Purpose Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature. Methods We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group. Results Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four non-traumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor. Conclusions Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality.
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Bauer S, Traverso A, Walch G. Locked 90°-double plating of scapular spine fracture after reverse shoulder arthroplasty with union and good outcome despite plate adjacent acromion fracture. BMJ Case Rep 2020; 13:e234727. [PMID: 32913063 PMCID: PMC7484859 DOI: 10.1136/bcr-2020-234727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2020] [Indexed: 11/04/2022] Open
Abstract
We report the case of a 74-year-old woman who sustained a scapular spine (SS) fracture after a fall 4 weeks after reverse shoulder arthroplasty (RSA). Open reduction and internal fixation (ORIF) with locked 90°-double plating resulted in union of the SS fracture with a good outcome (subjective shoulder value: 80%; Constant score 67; 1 year) despite of an adjacent lateral acromion fracture 3 weeks after ORIF. This is the second description in the literature of a successful double plate ORIF with union of an SS fracture after RSA. SS fractures are known to lead to poor RSA outcomes with a high mal-union rate and non-union rate. We describe the positioning of the plates and technical steps for successful ORIF to avoid complications, discuss the aftercare and report the outcome.
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Affiliation(s)
- Stefan Bauer
- Chirurgie de l'épaule, Service d'Orthopédie et Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - Aurélien Traverso
- Chirurgie de l'épaule, Service d'Orthopédie et Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland
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Shah SS, Roche AM, Sullivan SW, Gaal BT, Dalton S, Sharma A, King JJ, Grawe BM, Namdari S, Lawler M, Helmkamp J, Garrigues GE, Wright TW, Schoch BS, Flik K, Otto RJ, Jones R, Jawa A, McCann P, Abboud J, Horneff G, Ross G, Friedman R, Ricchetti ET, Boardman D, Tashjian RZ, Gulotta LV. The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II. JSES Int 2020; 5:121-137. [PMID: 33554177 PMCID: PMC7846704 DOI: 10.1016/j.jseint.2020.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous. Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests. Results The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; P < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; P = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%. Conclusions Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.
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Affiliation(s)
- Sarav S. Shah
- American Shoulder and Elbow Surgeons (ASES) Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
- Corresponding author: Sarav S. Shah, MD, 125 Parker Hill Ave, Boston, MA 02120, USA.
| | | | | | - Benjamin T. Gaal
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Stewart Dalton
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Arjun Sharma
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joseph J. King
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Brian M. Grawe
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Surena Namdari
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Macy Lawler
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joshua Helmkamp
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Thomas W. Wright
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Kyle Flik
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Randall J. Otto
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Richard Jones
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Andrew Jawa
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Peter McCann
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Joseph Abboud
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Gabe Horneff
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Glen Ross
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | - Richard Friedman
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
| | | | - Douglas Boardman
- ASES Multicenter Taskforce for RSA Complications, Rosemont, IL, USA
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Marigi E, Bartels D, Tangtiphaiboontana J, Ivanov D, Nguyen NT, Sanchez-Sotelo J. Acromial and spine fractures after reverse arthroplasty: Prevalence and risk factors. ACTA ACUST UNITED AC 2020. [DOI: 10.1053/j.sart.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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