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Acromial stress fracture following reverse total shoulder arthroplasty: incidence and predictors
- Source :
- Journal of shoulder and elbow surgery. 29(4)
- Publication Year :
- 2019
-
Abstract
- Background Increased use of reverse total shoulder arthroplasty (RTSA) has led to an understanding of unique complications such as acromial stress fractures (ASFs). The factors associated with ASFs are not fully known. This study investigates the incidence and predictors of ASFs following RTSA. Methods All RTSAs performed at a single tertiary referral hospital were retrospectively reviewed. ASF findings were classified as a definitive acromial or scapular spine stress fracture based on radiographic findings or stress reaction based on clinical findings (pain and tenderness at the acromion or acromial spine) without radiographic changes. Preoperative and postoperative radiographs were reviewed for radiographic predictors of postoperative acromial stress pathology. Clinical factors and implant characteristics were also investigated. Results Between September 2010 and January 2017, a total of 1170 RTSAs were performed, with 958 cases (81.9%) having at least 3 months' clinical follow-up (mean, 407 days; range, 90-1698 days). There were 40 ASFs (4.2%) and 61 acromial stress reactions (6.4%). For fractures and reactions, symptom onset averaged 8.8 and 7.3 months (P = .37), respectively, with durations of 4.5 and 2.9 months (P = .02), respectively, following RTSA. Independent predictors of acromial stress pathology were female sex, decreased change in deltoid length, and increased preoperative glenohumeral center-of-rotation medialization. Conclusion Acromion-related symptoms are common following RTSA. Female patients with increased preoperative center-of-rotation medialization had an increased incidence of ASFs. Although this study establishes which patients are at risk of ASFs, methods for prevention of ASFs in these patients remain unclear.
- Subjects :
- Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Radiography
Deltoid curve
Tertiary referral hospital
03 medical and health sciences
Fractures, Bone
0302 clinical medicine
Postoperative Complications
medicine
Humans
Orthopedics and Sports Medicine
Acromion
Aged
Retrospective Studies
Aged, 80 and over
030222 orthopedics
Stress fractures
business.industry
Shoulder Joint
Incidence (epidemiology)
Incidence
030229 sport sciences
General Medicine
Middle Aged
medicine.disease
Arthroplasty
United States
Surgery
medicine.anatomical_structure
Treatment Outcome
Arthroplasty, Replacement, Shoulder
Female
Implant
business
Subjects
Details
- ISSN :
- 15326500
- Volume :
- 29
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of shoulder and elbow surgery
- Accession number :
- edsair.doi.dedup.....bd4dc22367a0b549a9f39cc40b92ce92