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Influence of humeral lengthening on clinical outcomes in reverse shoulder arthroplasty - 20/05/23

Doi : 10.1016/j.otsr.2022.103502 
Kevin A. Hao a, Ethan W. Dean b, Keegan M. Hones a, Joseph J. King c, Bradley S. Schoch d, Natalie E. Dean e, Kevin W. Farmer c, Aimee M. Struk c, Thomas W. Wright c,
a College of Medicine, University of Florida, Gainesville, FL, USA 
b Piedmont Orthopedics | OrthoAtlanta, Atlanta, GA, USA 
c Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA 
d Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA 
e Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA 

Corresponding author at: Orthopaedics and Sports Medicine Institute, University of Florida, 3450, Hull Road, Gainesville, Florida, 32611, USA.Orthopaedics and Sports Medicine Institute, University of Florida3450, Hull RoadGainesvilleFlorida32611USA

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Abstract

Background

Deltoid tensioning secondary to humeral lengthening after reverse shoulder arthroplasty (RSA) is commonly theorized to be crucial to improving range of motion (ROM) but may predispose patients to acromial/scapular spine fractures and neurologic injury. Clinical evidence linking patient outcomes to humeral lengthening is limited. This study assesses the relationship between humeral lengthening and clinical outcomes after RSA.

Methods

A single institution review of 284 RSAs performed in 265 patients was performed. Humeral lengthening was defined as the difference in the subacromial height preoperatively to postoperatively as measured on Grashey radiographs. The subacromial height was measured as the vertical difference between the most inferolateral aspect of the acromion and the most superior aspect of the greater tuberosity. The relationship between humeral lengthening and clinical outcomes was assessed on a continuous basis. Secondarily, clinical outcomes were assessed using a dichotomous definition of humeral lengthening (≤25 vs. >25mm) based on prior clinical and biomechanical work purporting a correlation with clinical outcomes. Improvement exceeding the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for ROM and outcome scores after RSA were also compared.

Results

Humeral lengthening demonstrated a nonlinear relationship with postoperative ROM, clinical outcome scores, and shoulder strength and their improvement preoperatively to postoperatively. Furthermore, there were minimal differences in ROM measures, outcome scores, and shoulder strength when stratified using the dichotomous definition of humeral lengthening. No difference in the proportion of patients exceeding the MCID or SCB when stratified by humeral lengthening ≤25 vs. >25mm was found. There was no difference in humeral lengthening in patients with versus without complications.

Conclusion

No clear relationship between humeral lengthening and clinical outcomes was identified. The previously purported 25mm threshold for humeral lengthening did not predict improved patient outcomes. Outcomes after RSA are multifactorial; the relationship between humeral lengthening and outcomes is likely confounded by other patient and surgical factors.

Level of Evidence

IV; Case Series.

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Keywords : Arm, Distalization, Scapular spine, Acromion, Fracture, RTSA


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Vol 109 - N° 4

Article 103502- juin 2023 Retour au numéro
Article précédent Article précédent
  • Does isolated glenosphere lateralization affect outcomes in reverse shoulder arthroplasty?
  • Joseph J. King, Keegan M. Hones, Thomas W. Wright, Christopher Roche, Joseph D. Zuckerman, Pierre H. Flurin, Bradley S. Schoch
| Article suivant Article suivant
  • Glenoid reconstruction bone loss with a pediculated coracoid autograft during shoulder arthroplasty. A technical note
  • Alexandre Lädermann, Naif AlAmer, Patrick J. Denard, Tiago Martinho, Juan A. Hurtado, Philippe Collin

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