Impact of accumulating risk factors on the acromial and scapular fracture rate after reverse total shoulder arthroplasty with a medialized glenoid–lateralized humerus onlay prosthesis

Roche, Christopher; Fang, Wen; Simovitch, Ryan W.; Zuckerman, Joseph D.; Routman, Howard

doi:10.1016/j.jse.2022.12.026

Cited by 5 publications

(12 citation statements)

References 24 publications

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“…The ASES multicenter study 10 found a 2.14-times greater odds of an acromial fracture (95% CI, 1.41-3.26, p < 0.001) and 2.12-times greater odds of a SS fracture (95% CI, 1.07-4.20, p = 0.031) in patients with CTA compared with patients with primary GHOA. Other studies have reported an increased odds ranging from 1.60 to 4.74 14,26 . This is a risk factor of grade C evidence 27 .…”

Section: Patient Risk Factorsmentioning

confidence: 89%

“…The ASES multicenter study 10 determined that patients with a history of any inflammatory arthritis, including RA, had a 2.90-times greater odds of acromial and SS fractures (95% CI, 1.08-7.78, p = 0.035). Other studies have reported a range of 2.30 to 3.14 13,14,26 . Of note, this risk factor carries a higher risk than osteoporosis.…”

Section: Patient Risk Factorsmentioning

confidence: 91%

“…Female sex is a risk factor of acromial and SS fractures after RSA, with a 1.81-times greater odds reported by the ASES multicenter study 10 compared with male patients (95% CI, 1.20-2.72, p 5 0.007). Other studies have reported an increased odds ranging from 1.51 to 2.75 [12][13][14]26 . This is a risk factor of grade B evidence 27 .…”

Section: Sexmentioning

confidence: 99%

“…Rheumatoid arthritis (RA) is a known risk factor of acromial and SS fractures after RSA 13,14,26,29 . This is likely a result of increased osteoclast stimulation leading to osteopenia 30-32 .…”

Section: Patient Risk Factorsmentioning

confidence: 99%

“…Body mass index (BMI) has not been reported as a risk factor of acromial and SS fractures 8,13,14,17,18,26,33 . However, all of these studies investigated this variable in a linear manner or between fracture and non-fracture groups rather than on an ordinal, categorical scale 8,13,14,17,18,26,33 . The relationship between BMI and acromion and SS fractures after RSA is unclear.…”

Section: Patient Risk Factorsmentioning

confidence: 99%

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Mitigating Fracture of the Acromion and Scapular Spine After Reverse Shoulder Arthroplasty

Buchanan,

Bindi,

Caban-Klepac

et al. 2023

JBJS Reviews

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» Biomechanical studies report that thin scapular spine (SS) morphology, superiorly placed glenoid components, and increased glenoid baseplate screws contribute to increased acromial and SS strain and may increase fracture risk. » Clinical risk factors of acromial and SS fractures after reverse shoulder arthroplasty include increasing age, female sex, osteoporosis, rheumatoid arthritis, thin midsubstance acromion morphology, previous acromioplasty, and surgical indication of cuff tear arthropathy. » Clinical studies show that, in isolation, excessive humeral lengthening, humeral lateralization, and glenoid medialization may increase risk of acromial and SS fractures. » Biomechanical studies suggest that a combination of glenoid medialization and humeral lateralization (MG/LH) may reduce fracture risk, although this requires clinical correlation. » Surgeons might reduce fracture risk in patients of high-risk groups by guarding against excessively lengthening the humerus, using a MG/LH prosthesis, and targeting screws to avoid the scapular notch and base of the SS. Level of Evidence: Level V. Narrative Review. See Instructions for Authors for a complete description of levels of evidence.

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Section: Patient Risk Factorsmentioning

confidence: 89%

Section: Patient Risk Factorsmentioning

confidence: 91%

Section: Sexmentioning

confidence: 99%

Section: Patient Risk Factorsmentioning

confidence: 99%

Section: Patient Risk Factorsmentioning

confidence: 99%

See 3 more Smart Citations

Mitigating Fracture of the Acromion and Scapular Spine After Reverse Shoulder Arthroplasty

Buchanan,

Bindi,

Caban-Klepac

et al. 2023

JBJS Reviews

Self Cite

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Managing rotator cuff tear arthropathy: a role for cuff tear arthropathy hemiarthroplasty as well as reverse total shoulder arthroplasty

Stenson

Mills

Dasari

et al. 2024

Journal of Shoulder and Elbow Surgery

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Pectoralis Major Transfer For Anterior Recurrent Dislocation of Reverse Total Shoulder Arthroplasty: A Case Report

Baek,

Kim,

Kim

2024

jocr

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Introduction: Reverse total shoulder arthroplasty (RTSA) has revolutionized the treatment landscape for a spectrum of shoulder pathologies, extending its indications from rotator cuff arthropathy to encompass irreparable rotator cuff lesions, fractures, inflammatory arthritis, and tumors. However, the exponential increase in RTSA usage has brought a proportional rise in associated complications, with dislocation being one of the most common early post-operative complications. Case Report: This case report details a 65-year-old right-hand dominant male patient presenting with chronic pain and weakness in the right shoulder, diagnosed with advanced glenohumeral arthritis and massive irreparable rotator cuff tears. The patient underwent a Bony Increased-Offset RTSA (BIO-RTSA) procedure, coupled with subscapularis repair. Postoperatively, the patient experienced pain and instability, culminating in an atraumatic anterior dislocation at 4 months. Despite conservative management, recurrent dislocations persisted. Revision surgery was performed with an increase in the linear component size for containment. About 1 year postoperative of the revision surgery, recurrent dislocation reoccurred. Re-revision surgery was performed with secondary pectoralis major (PM) transfer for subscapularis deficiency due to re-tear from recurrent dislocation, and with an increased humeral tray size for better containment. About 1-year and 6-month post-operative to the re-revision surgery, the patient achieved restored stability, improved range of motion, and reported satisfaction with the outcome. Conclusion: This case report underscores the challenges of managing recurrent anterior dislocation after RTSA. The successful use of secondary PM transfer highlights its efficacy as a salvage procedure in restoring stability for persistent anterior dislocation after RTSA. Yet, further clinical studies are warranted to establish the role of such interventions in the management for RTSA-associated complications. Level of Evidence IV; Case report Keywords: Reverse total shoulder arthroplasty, pectoralis major transfer, irreparable rotator cuff tear, rotator cuff arthroplasty, tendon transfer.

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Impact of accumulating risk factors on the acromial and scapular fracture rate after reverse total shoulder arthroplasty with a medialized glenoid–lateralized humerus onlay prosthesis

Cited by 5 publications

References 24 publications

Mitigating Fracture of the Acromion and Scapular Spine After Reverse Shoulder Arthroplasty

Mitigating Fracture of the Acromion and Scapular Spine After Reverse Shoulder Arthroplasty

Managing rotator cuff tear arthropathy: a role for cuff tear arthropathy hemiarthroplasty as well as reverse total shoulder arthroplasty

Pectoralis Major Transfer For Anterior Recurrent Dislocation of Reverse Total Shoulder Arthroplasty: A Case Report

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